Education Production Assistant Form

EDUCATION PRODUCTION ASSISTANT FORM

Use this form to apply for assignment as a Production Assistant for educational productions and departmental media projects. The information provided will be used to determine assignment eligibility, training requirements, access privileges, and any required background screening or certifications. By signing the form, the applicant certifies that all information is true and acknowledges the terms and conditions set forth below.

Student Information

Date of Birth:    Grade / Program:

Parent / Guardian (If applicant is under 18)

If the applicant is a minor, a parent or legal guardian must provide contact information and agree to the acknowledgements below.

Production Assignment Details

Production dates: to    Expected hours per week:

Stipend    Course credit    Volunteer / Unpaid

Equipment, Access & Training

Applicant may be authorized to handle the following equipment (check all that apply):

Cameras    Lighting    Audio    Editing workstations    Set construction

Required training completed or scheduled (check applicable):

Safety & hazard training    Equipment operation training    Privacy and confidentiality    Access card / key required

Safety, Conduct & Legal Acknowledgements

By signing below, the applicant acknowledges and agrees to comply with all departmental and institutional safety rules, studio protocols, and applicable laws while participating in production activities. The applicant agrees to follow supervisor instructions, complete required safety and equipment training prior to unsupervised operation, and to report unsafe conditions immediately.

The applicant recognizes that certain production activities involve physical risk. To the maximum extent permitted by law, the applicant accepts responsibility for personal safety and property under their control and agrees to hold the institution, its officers, employees, and agents harmless for claims arising from the applicant’s own negligence or willful misconduct. This paragraph does not waive rights or liabilities that cannot be lawfully waived.

Media Release & Confidentiality

Productions may be recorded for instructional, promotional, or archival purposes. By checking the consent box below, the applicant grants the institution a non-exclusive, royalty-free right to use photographs, audio, and video recordings of the applicant made in connection with the production for educational and promotional purposes, subject to institutional policies and applicable law.

I consent to the use of my image and recordings as described above.    I agree to maintain confidentiality of any restricted materials or student records encountered.

Background Check & Identification

Certain assignments may require background screening or proof of identity. By checking the box below, the applicant authorizes the institution to conduct such screening where permitted and acknowledges that assignment may be contingent on satisfactory results.

I authorize background screening as required and understand assignment may be conditional.    I will provide required identification documents upon request.

Emergency & Medical Information

Acknowledgements (initial/checkbox)

I confirm I am an enrolled student in good standing or otherwise authorized to participate.

I have read and will comply with departmental production policies, health & safety protocols, and equipment usage rules.

I acknowledge potential risks associated with production activities and accept responsibility for my actions; I understand this does not waive rights that cannot be lawfully waived.

Certification

I certify that the information provided on this form is accurate and complete. I understand that falsification, omission, or misrepresentation of information may result in denial of assignment or removal from production activities. I authorize verification of any information contained herein as necessary for the assignment process.

Sign Now