Accident on Set | Form 01-AFS Film School Application

Film School Application – Student Initiatives

If a required field (indicated by *) does not apply to you, please enter N/A. You will not be able to proceed without doing so.

Terms & Conditons*

I agree, I acknowledge that my coverage will only begin once my application has been approved and payment has been received. Please note that same-day application coverage is not available. If you require urgent coverage, please contact AFBS directly.

School Information

Name of School*

Department*

School Address*

School Address (Suite, Number, and Street Name)* City* Province* Postal Code*

Contact Name*

Contact Telephone*

Contact Email*

Contact Fax

Policy Information

Policy Duration*

Annual

Semester

Semester*

Fall

Spring

Summer

Semester Start Date*

MM slash DD slash YYYY

Semester End Date*

MM slash DD slash YYYY

Anticipated number of ACTRA and/or UBCP/ACTRA performers engaged*

Please enter a number greater than or equal to 0.

Anticipated number of student-initiated projects*

Please enter a number greater than or equal to 0.

Anticipated average number of days (including partial days) of engagement of ACTRA and/or UBCP/ACTRA performers per project*

Please enter a number greater than or equal to 0.

Is it anticipated that student-initiated projects will involve any of the following?

Stunt action*

Yes

Physical action*

Yes

Intimacy scenes*

Yes

Physical action is defined as any movement or activity beyond normal walking and talking, and could include dancing, swimming, running, tripping, shoving, paddling, jumping, falling or where padding or mats are being used.

When a YES response is provided, coverage requires submission, in advance, of additional details for each production where stunt or physical action occurs or when intimacy scenes are enacted.

Will project locations occur outside the province in which the school is located?*

Yes

If YES, please specify locations*

I/We hereby request enrolment in the AFBS Accident on Set Insurance Program, as described in the provisions of the Master Insurance Policy for the period outlined above, subject to extension by mutual agreement for ACTRA and/or UBCP/ACTRA performers only who are engaged by the film school named above in student initiated projects.

The acceptance of this Application is at the discretion of AFBS and subject to the issuance of a Certificate of Insurance to the named Film School. I/We understand that acquiring Accident on Set insurance does not change nor waive any liability to register with a workers’ compensation program, if required.

I/We understand that acceptance of this Application is conditional on the undersigned accepting all the terms and conditions of the Policy, which includes all provisions, and/or endorsements attached to said Policy and the requirement that the named school maintains general liability insurance coverage.

I accept*

By selecting the “I accept” button, I am signing this document electronically. I agree that my electronic signature is the legal equivalent of my manual/handwritten signature on this document. By selecting “I accept” using any device, means, or action, I consent and agree to the legally binding terms and conditions contained in this document and confirm that I am applying for AOS coverage as described herein on behalf of the named production. I further agree that my signature on this document is as valid as if I signed the document in writing, and confirm that I am authorized by the named production to enter into this Agreement.

Name of Authorized Signatory*

Title*

Date Signed*

MM slash DD slash YYYY

Film School Application – Student Initiatives

School Information

Policy Information

Email

Phone

Toronto Address

Vancouver Address