Amherst Community Access Television
Cablecast Request Form
Possible Controversial Content:
(please check all that apply and provide a
description on the lines provided below.)
NOTE: Certain types of content must be shown during certain hours and require a disclaimer.
In consideration of Amherst Community Access Television permitting the cablecast of this program,
the undersigned agrees that he/she:
Is familiar with the nature of the program material and accepts full responsibility for the
program content submitted
Has obtained the necessary releases, licenses, and any other permissions necessary to
cablecast this program and will provide such upon request
Releases ACAT, the Amherst Communications Infrastructure Committee, the Town of Amherst, and
any of its employees and officers, to indemnify and hold them harmless from all claims for damage,
loss or theft of this program while in their custody
Is familiar with and agrees to abide by all ACAT policies and procedures
(Signature of Producer, if 18 or older, or Parent/Guardian, if Producer is under 18)
Producers Name: Phone:
Program Title:
Subject of Program:
Type: Regular Series Limited Series One-Time Special
Frequency: Monthly Bi-Weekly Weekly Other
Requested Air Date(s):
Do Not Air After:
Program Length:
Language Adult Content
Libel or Slander Nudity
Violence Copyright
Date:Producers Signature
Pre-roll time
DV Tape
VHS Tape
Print Form
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