1
Motion Picture Filming and Television Production Permit Application
For filming on Regent University Campus
Fill out this form and forward to your instructor for approval. The instructor will forward it to the
proper office for further approval and processing.
Allow 2 weeks for processing.
Project Title:
Class:
Class Professor:
Student Applicant:
Student email:
Today’s Date:
Professor Extension:
Position on Project:
Student Phone:
Production Dates (To be covered by this Permit)
Hours of Filming (e.g. 730a-10a):
1.
Production Type
Still Photography Webisode Narrative Film Music Video
Corporate/Training Video Documentary
Other (Describe):
2.
Total Personnel: Total Vehicles/Equipment:
3.
Vehicle Detail:
Cars: Trucks: Generators: RVs: Other: _
4.
Equipment Detail: List all equipment (camera, lights, sound) that will be used for filming:
5. Will there be children under the age of 16 on set? Yes No
6. If yes, have you obtained a theatrical permit for the minor? Yes No
7. Location Shoot Specifics
On the following page, please list the specifics for each filming location, including buildings, and exterior
structures or pathways that are in the shot composition, and a summary of each shot (including animals, children,
stunts, weapons, etc.). Attach additional sheets if necessary.
2
The following chart is a summary of the information provided above. Please be detailed, an example is given.
Dates(s)
#
Approve/Deny
(Office use only)
Location, Activity, Details of Scene P/F/S *
Oct 1, 2015
Ex
SC Ordinary, upper level: two students will be seated, eating,
and discussing a group project theyre working on. One
student will squirt ketchup on the group notebook.
P: 7:30a
F: 8a
S: 9a
1
2
3
4
5
6
*Prep/Film/Strike Time
8.
Filming within the Public Right of Way
If filming is planned on campus streets, please submit a site plan (campus map) showing location(s) of filming, cast,
crew, vehicle(s), and route(s) traveled in order to film a scene. Note: Campus police must be utilized for any filming
on campus roads.
9. Stunts/Special Effects: If your project will include stunts or special effects (smoke), please provide
detailed Information about the stunts/special effects planned:
Note: No pyrotechnics are allowed on campus property. Squibs may be used, but only by a licensed professional.
Licensed Professional:
Licensed Professional Phone & Email:
License #:
3
1
0.
Mock
Weapons:
Please list any mock weapons to be utilized in your shoot.
Note: University police are required to conduct a weapons check for any filming on
campus with mock
weapons. If your request is approved, contact Campus Police at 757-226-2075 thirty minutes before your
shoot to arrange for an officer to inspect the mock weapon(s). No live weapons are allowed anywhere on
Regent
University property.
Applicant’s Signature:
Date:
Professor’s Signature:
Date:
Step-by-Step:
Students: Fill out this form, sign, and submit by email to your instructor for approval. All detail must be included
or processing will be delayed. Allow 2 weeks for all processing and approvals.
Instructors: Read the form, sign, and submit by email to the proper office for approval and room reservations.
For com arts areas: email to techscheduling@regent.edu.
For all other campus areas, email to adminservices@regent.edu.
S n ture/ om ents/ ees or ond ons
*Police Dept.
A
dmin. Services
T
ech. Ops.
Police Dept. approval only required if mock weapons will be used.
e re A hments
o Sp ial h n s R qui d T ffic Con ol lan
Any on No s or ond ons of A rov
Perm # RCPD A r e D e
This permit will be effective (Date & Time) Through (Date & Time)
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