location release form

I, ___________________________________________________, give permission to _______________________________________________ to videotape, photograph or produce an image of my (our) residence, office, property or building and use such, both interior and exterior, as a location for a student video project.

Student video project title: ___________________________________________________

This property is located at: __________________________________________________

Student video production personnel shall be granted access to the above property during:

Date: ____________________________    Time: ____________________________

Permission is granted for access to the property to allow the visual recording of scenes (interior and exterior) for a student video project. This includes any person(s) or equipment, including but not limited to: cameras, lights, microphones, props and costumes necessary for the student video production.

The permission is also granted for the broadcast and distribution rights of this student video production, which may be viewed on video, television, the Internet and other media.

The student video production staff is responsible to leave the location in its original condition and to remove all equipment items associated with the student video production.

Signed: ______________________________________________

Location: _____________________________________________

Witnessed by: _________________________________________

Location owner: ________________________________________

Student representative: ____________________________________