Student Film Production Insurance Application

1Insurance Application > 2Faculty Supervisor Signature
Note to Students

Please note that applications should be submitted at least a week in advance of filming. Complete this application as completely as possible as missing information can delay in the approval process.
Insurance documentation can take up to 24-hours to produce, and can only be issued on weekdays.
Student & Course Information
Name of Applicant: Name of Applicant: * First Last
Student Number: *
Your Email: *
Undergraduate or Graduate: *
Course Number and Title: *
Professor(s)/Supervisor(s): *
Professor(s)/Supervisor(s) email: *
Project Information
Title of Project: *
Genre/Type e.g., fiction, documentary, alternative, etc.
Brief Synopsis: *
Is this project an original screen play? *
Please provide a copy of any licenses, clearances, and consent from the screenplay owners:

Attach Files
Will your production include any risky activities (includes special effects, choreographed fights, stunts, use of replica weapons, etc.): *
Please elaborate on the types of risky activities, and how they are intended to be filmed: (Please indicate if any of the actors who will engage with risky activities are ACTRA. Certain risky activities are subject to review from other departments.) *
Will any of the music be unlicensed? *
Please elaborate on use of unlicensed music. *
Please attach a copy of the script *

Attach Files
Actors
Is this production hiring ACTRA actors? *
How many ACTRA actors? *
Please indicate if the ACTRA actors will be involved in any of the following:

Please indicate if the ACTRA actors will be involved in any of the following: Stunt Action Intimacy Scenes Physical Action (defined as any movement beyond normal walking and talking, and could include dancing, swimming, running, tripping, shoving, paddling, jumping, falling, or where padding or mats are being used) Filming outside of Ontario Other (an action or scene that is not listed above):
If filming outside of Ontario, please contact the ACTRA representative to discuss how to purchase worker's compensation insurance coverage. *

If filming outside of Ontario, please contact the ACTRA representative to discuss how to purchase worker's compensation insurance coverage. I will contact ACTRA to inquire about coverage information.
Please indicate which kind of physical action ACTRA Talent will be involved in. *
If ACTRA talent are to be used in Stunt Action, Intimacy Scenes, or other scenes with actions NOT described in the above description of Physical Action, a separate Risk Assessment will need to be conducted with Accident on Set insurance. Provide a detailed description of the scene, including how you are planning to film it. Please allow for an additional 2 business days of review. *
Are there any minors (under 18) involved in your production? *
If yes, how many? Please describe their role(s) in the film. *
Will there be parental supervision on set? *
Space and Equipment
Will you be using any York University equipment? *
Will you be renting any equipment from an external organization? (includes cameras, lighting, props, etc.) *
Please list all external organizations from which you plan to rent equipment from.

Please include the following information for each organization: Name of Company | Service (ex. Equipment Rental) | Description of Equipment or Space | Pick-up/start date - Return/end date *
1. 2. 3. 4. 5.
Please provide a list of ALL shooting locations and dates: (example: Locations | Dates Filming) *
1. 2. 3. 4. 5.
Rescheduling Shooting Dates: If additional filming dates are required, please let Risk Management know. Insurance documents may need to be revised to reflect any additional filming. *

Rescheduling Shooting Dates: If additional filming dates are required, please let Risk Management know. Insurance documents may need to be revised to reflect any additional filming. I will inform Risk Management of any changes in filming dates, including rescheduled dates or additional dates.
Have any external organizations or locations asked for proof of insurance? *
Please provide the complete name and address of each organization or location asking for proof of insurance. Include any requirements they have listed (ex. dollar amounts, additional insured, etc.). Any provided documents can be attached at the end of the application or can be emailed to Risk Management directly (riskmgmt@yorku.ca). *
Will you be filming with drones/UAVs? *
Please describe the planned use of drones for filming, including locations where the drone would be used. *
Does the project involve travel outside of Ontario? *
Please indicate locations outside of Ontario: *
Is a vehicle needed for this project? (renting a vehicle for transporting items, using a vehicle for a scene in the film, etc.) *
Please indicate what vehicles will be used for this production and any additional information that RMS would need to know. Please note that university insurance coverage does not extend to vehicles. *
Health Orders & Public By-laws
PRODUCTION WILL BE COMPLIANT WITH PUBLIC HEALTH ORDERS AND PUBLIC LAWS. *

PRODUCTION WILL BE COMPLIANT WITH PUBLIC HEALTH ORDERS AND PUBLIC LAWS. Yes
Clearance Procedures

All Projects must be cleared/approved by supervisory faculty.
All necessary licenses, clearances, and consents from contributing parties must be obtained in writing.
Written agreements must be in place with ALL contributors and contractors.
Risk Management will provide final evaluation and approval. Additional approvals from other University departments may be needed as indicated by Risk Management review.

Risk Management Review - Risk Management will begin their review of your application within two (2) business day of receiving it - if you do not hear from Risk Management, please confirm with your supervisor that they have completed their portion of the application.
*

I understand the clearance procedures as outlined above
Student Signature:

Clear
Use mouse or trackpad to sign
Date: Date: / MM / DD YYYY
Attachments
Attach with the application a copy:
1. Copy of the Student Finance Agreement (if applicable)
2. Copies of agreements with organizations where available (if the organization is listed as an exception, agreement is not required.)
3. Any documents provided by external organizations or locations listing insurance requirements.

Attach Files
Send completed form to your course director
Please enter your course director’s email address *

A special link will be sent to your course director to the email address provided.

Student Film Production Insurance Application

Student Film Production Insurance Application

Note to Students

Student & Course Information

Project Information

Actors

Space and Equipment

Health Orders & Public By-laws

Clearance Procedures

Attachments

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