$5 Film Club sign up

Hello, 

$5 Film Club will held every Wednesday from 4 pm - 5 pm at the Medfield TV Studio. 

Our goal is to collaborate with students on fun film activities to teach them various skills related to media. These activities may include scene recreation, creating sound effects, and mad-lib news, to name a few. Every student will have the chance to operate a camera, take on directing responsibilities, edit, and engage in all aspects of production. 

Please fill out this form BEFORE your first session you plan on attending. 

Thank you!

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Email *
Parent First Name *
Parent Last Name *
Emergency Contact Phone Number *
Student(s) Name

Waiver

In consideration of my child’s acceptance and participation in the MCCAC youth program, I, to the full extent permitted by law, hereby release, defend, hold harmless, and indemnify MCCAC and its members, officers, directors, committee members, agents, instructors, and employees from any or all liability for any claim, loss, damages, liabilities, expenses, bodily injury, or death, including any such liability that may arise out of the negligence of any of the Indemnities or may be suffered or claimed by me as a result of an investigation of, action concerning, or communication of my background in connection with this document. 

I further confirm I have read, understand, and agree to conform to the rules, regulations, and policies of MCCAC, the MCCAC Youth Media Program (ie: MCCAC Youth Protection Policy), and its affiliates. 

If any provision of this agreement is determined to be illegal or unenforceable, the remaining provisions shall remain in full force and effect. By signing this document, I acknowledge that I have read this document, agree to it, and fully understand its contents.


By typing your name below you agree to sign off on the above. Thank you!

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Todays Date *

Media Release

I hereby consent to permit MCCAC and any organization(s) supporting a MCCAC Youth Media Program class / workshop / seminar financially or as an instructor to transmit or record on film, tape or otherwise, my child’s voice and / or picture, name, likeness, or performance / visual art / musical composition in its entirety or parts of, for unlimited playback on television and over the internet for this program and others going forward. I also permit MCCAC to supply recordings thereof to other broadcasting / cable casting organizations and also extend to the use of my child’s name and likeness, any portion of my child’s performance / visual art / musical composition, and biographical information about my child for any educational or promotional purpose. The absence of my signature below represents my choice to opt out of this Media Release.


By typing your name below you agree to sign off on the above. Thank you!

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Todays Date *
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