Historical Building Filming Consent Form
Applicant Information
Name of Applicant/Production Company
Contact Person
Email Address
Phone Number
Filming Details
Name/Address of Historical Building
Date(s) of Filming
Purpose/Description of Filming
Areas to be Accessed
Number of Crew Members
Equipment to be Used
Terms & Conditions
I have read and agree to the terms and conditions above.
Applicant Signature
Date
For Official Use Only
Consent Given By
Date