Online Form - Request to Film Form » Shire of Serpentine Jarrahdale

Filming location (include nearest street address): *

Date from: *

Date to:

Full name: *

Organisation: *

Mobile: *

Email:

Brief description of film content and purpose: *

Number of cast and crew on set: *

Number of vehicles on set: *

Please provide details of any amplified sound system to be used on set:

Please provide details of any temporary structures (including scenery/sets, gazebos, marquees etc) that you will be erecting on site:

Will any part of your set up or filming be on a road or footpath? If yes, please provide details below.

If you are using a drone on set, please attach your CASA Accreditation Certificate:

Maximum size of ALL attachments is 976.56 MB

Would you be willing to provide some raw video footage or photography to the Shire for it to use for its own purposes (after a stated time)?:

YesNo

Please attach a site plan showing your set up including all temporary structures and parking: *

Maximum size of ALL attachments is 976.56 MB

Please attach a copy of your Public Liability Insurance Certificate of Currency (must be valid for the filming dates and minimum of $10 million): *

Maximum size of ALL attachments is 976.56 MB

Do you have a Risk Management Plan for this production?

YesNo

Additional information (Optional):

Declaration: I acknowledge and agree to the following Terms and Conditions:

YesNo

All relevant traffic and road rules will be complied with at all times.
Access to adjoining properties will be maintained at all times.
Adjoining property owners will be notified of the filming schedule and activities.

The notice must include a contact name and mobile number for someone who will be on site at all times during filming.

Address details for the property and adjoining land owners can be provided by the Shire but personal information including name, email and phone details cannot be made available due to privacy legislation.

The filming location must not be altered in any way and must be left in the same condition in which it was found.
All equipment, temporary infrastructure and rubbish must be removed from the location at the end of filming.
Your organisation will be charged for the cost of any damage or cleaning to the road, verge, footpath or other Shire assets, resulting from the filming activity.
The Shire of Serpentine Jarrahdale is to be indemnified against liability for all claims that may arise as a result of filming.
The Shire of Serpentine Jarrahdale is not liable for any loss, damage, theft, death or injury that occurs as a result of filming.

Additional attachment:

Maximum size of ALL attachments is 976.56 MB