STEELTOWN ENTERTAINMENT PROJECT YOUTH & MEDIA DEPARTMENT “TAKE A SHOT: TEEN FILM PRIZE”

CONTEST LOCATION PERMISSION AND RELEASE FORM

If you are shooting in a school or public place, you do not need to fill out this form. Please fill out this form ONLY if you are filming in a private location. Call 412-251-0890 with any questions.

Production (working title): ____________________________________________________________________________Producer(s): ____________________________________________________________________________

Director(s): ____________________________________________________________________________Date(s) of filming on location: ____________________________________________________________________________

I/We, the undersigned, hereby grant to the producer and her/his production crew permission to use the property and its adjacent area located at

Address: ____________________________________________________________________________City: __________________________State: _________ Zip: __________for the purpose of filming and audio recording interior and/or exterior scenes for the production of the above mentioned production. I/We also assign all rights and release from liability for the recording, editing, exhibiting, sale, and distribution of the visual images and sounds filmed and recorded at the abovementioned location for the production of the above-mentioned project. This permission covers the following: The right to bring to the above-mentioned location filming personnel and equipment. For a basic production such as this, said production will consists of the following:  A producer, director, camera operator, audio technician, interviewer and/or 1-4 talents; also included  1-3 cameras, field monitor, microphone(s), lighting equipment, props, and other equipment needed in the production. The above-mentioned producer has the right to distribute this program as he/she sees fit. This could include television spots, video competitions, and/or educational instruction. I/We waive any right to compensation. PROPERTY OWNER or official and/or legal representative of the property owner (must be over 18 years of age)

Printed name: ____________________________________________________________________________Signature: ____________________________________________________________________________Date: _______________________