SCM

OFF-CAMPUS RELEASE FORM

STUDENT PRODUCTIONS

Producer/Director: _____________________________Name of Production: _________________________

School: ______________________________________Revision? Yes_______________ No ____________

We are producing a film in connection with our course work at City University. In order to complete this course work, we would like to film at the off-campus location listed below. To induce the owner or occupant of that location to grant us free use of that location for our filming, and City University to intercede on our behalf with the owner or occupant by providing the owner or occupant with a limited indemnity, if so requested by owner or occupant, we hereby jointly and severally release City University, its trustees, employees, agents and representatives, and

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(Name AND Mailing Address of Owner or Occupant - CANNOT BE THE STUDENT PRODUCER OR DIRECTOR NAMED ON THE RELEASE AND/OR REQUEST FORM; THIS IS FOR THIRD PARTY INSURANCE ONLY; PLEASE CONSULT THE CITYU INSURANCE OFFICE FOR FURTHER DETAILS)

from any and all liability to, and agree not to raise any claim or institute any legal action in favor of, any or all of us which arises out of or in connection with the filming at this location, This release shall apply to loss of or damage to the property of any of us, and to personal injury (including death) that any of us suffer, including and without being limited to, any loss, damage, or injury sustained or allegedly sustained by any of us due to the negligent acts or omissions of the trustees, employees, agents or representatives of the University, or of the owner or occupant or his/her/their/its employees, agents, or representatives.

We fully understand and assume all risks, dangers, and responsibilities connected with our filming at this location,

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Signature of Producer, Director or Head of Group Date

Location(s) to be insured: _____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Date(s) [with Rain Dates] __________________________________________________________________

LISL ALL CAST AND CREW MEMBERS:

Names (Print) Signature Names (Print) Signature

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(Use the back of this form for additional names and signatures)

I certify that the use of this location on these dates is occurring in connection with course work at City University.

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Signature of Supervising Faculty Date