Accident on Set | Form 14-RA

"*" indicates required fields

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.

Application – Alberta Stunt Performers Only

Individuals participating in an extreme sport or excessive risk activity, as outlined below, are excluded from coverage.

Producer Information

Production Company*

Production Title*

Contact Name*

If your Production involves stunt or risk performances, please provide a brief description in the box below. AFBS reserves the right to assess the level of risk.

Description of Action*

Please provide a copy of your cast list.

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*

Application – Alberta Stunt Performers Only

Producer Information

Email

Phone

Toronto Address

Vancouver Address