Media Center

Lights! Camera! Community Action! 

MEDIA CENTER LOCATION RELEASE

    ________________________ hereby grants permission to

(Name of agent or owner)

 _________________________ to temporarily locate community television remote production equipment upon the property located at __________________________________________________

on the following date and times: ________________________________________________________________________

Permission is further granted for the appearance of this location in any program resulting from the above described use of said property.  I understand that editorial control is fully granted to the program producer.

I also undertstand that the Midpeninsula Community Media Center is responsbile for any injuries or liabilities which occur because of video equipment while it is on the property.

I certify that I am the legal authorized agent or owner of this property and empowered to execute this document.

Signature _____________________________________________________  Date _______________________________________

(Agent or Owner)

Signature ______________________________________________________  Date _______________________________________

(Producer)

The Media Center, 900 San Antonio Road, Palo Alto, CA 94303, 650-494-8686.