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for the
MiNiFLiCK Contest

You must submit this form if you film on private property other than your own.

I ______________________________________ as owner of the property at ____________

____________________ give permission to ___________________________________________

to access and enter upon the abovementioned property for the purposes of photographing and

recording on video, scenes for the film ______________________________ made by

_________________________________ for the Raincoast Education’s “More Than Just Mud”

MiNiFLiCK Contest. Furthermore, I certify that I have the right to authorize this use and enter into

this agreement, and that it does not require consent from any third party.

Permission includes the right to bring equipment and personnel onto the property for the

purposes of filming as well as the right and responsibility to remove the same from the property

upon completion of work. The filmmaker(s) agree(s) to use reasonable care to prevent damage to

the property and will restore it to its original condition (minus reasonable wear and tear).

I hereby authorize the Raincoast Education Society, its employees, representatives and

assigns, the right to use, reproduce, edit, publish or distribute video images of my property in the

film, in perpetuity, for the purposes of education and promotion, without compensation to me.

________________________________________ Date: _________________________________

(Printed name)

E-mail: __________________________________ Phone: ________________________________

Address: _______________________________________________________________________

This contest is sponsored by the Raincoast Education Society with
funding from the Habitat Conservation Trust Fund.