* required

In order to properly evaluate the hazards involving stunts used in filming, please provide the information requested below. Additional information may be requested upon receipt and review of below.

1. Type of Scenes being filmed

2. List stunts by type, location*, and date (*exact street address, please)

3. Protective measures used to protect participants and public

4. Who is employer of record of persons performing stunts

5. How many people involved in stunt scenes? Number of takes?

6. Experience of stunt people in performing similar stunts? Any injuries or losses redulting from performing similar stunts? If yes, please give specifics.

Additional Comments/Special Instructions

* Email address