Film Location Release Form
Property Owner's Name
First Name
Last Name
Filmmaker Name
First Name
Last Name
Project Title
Production Company
Location
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Description of Premises
Filming Dates From
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
To
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Fee $
I, the property owner, agree with the following statements.
In consideration of the fee indicated above, IÂ permit the production company participants to enter and remain the property between the dates described above for their film production.
This permission includes right to take motion pictures, videotapes, sound recordings.
I certify that I have the full right and authority to enter into this agreement and grant the rights herein granted, and that the consent or permission of no other person, firm, or entity is necessary in order to enable you to exercise or enjoy the rights herein granted.
Date
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Property Owner's Signature
Submit
Should be Empty: