Medical Information, Release and Agreement to Rules of Residence

Medical Information Release and Agreement to Rules of Residence

Please fill out this form at least one week before the start of your film school course.

Student Name*
FirstLast
Address*
Street AddressAddress Line 2CityState / Province / RegionZip / Postal CodeCountry
Phone*
Email*
Cell Phone (if applicable)
Fax (if applicable)
Website (if applicable)
Birth Date*
Age*
Please enter a value between 9 and 99.
School (if applicable)
Grade (if applicable)
Emergency Contact 1:*
FirstLast
Relation
Phone*
Emergency Contact 2*
FirstLast
Relation
Phone*
MSP Group
Care Card #*
Doctor
Phone
Dental Group
Dental Plan ID #
Dentist
Phone
Special Medical Concerns*
- None
- Medical Alert
- Allergies
- Medication
- Special Diet
- Activity Restrictions
Details of above conditions:
Agreement to Rules of Residence at GIFTS*
I understand that during my stay at the Gulf Islands Film & Television School, there will be ABSOLUTELY NO DRUGS or ALCOHOL permitted. I understand that if I am found to be using or in possession of drugs or alcohol at GIFTS, I will be IMMEDIATELY dismissed from the course. There will be NO REFUNDS given to students who are expelled for drug or alcohol use or possesion. I understand that I may also be dismissed for dangerous or excessively disruptive behaviour. I understand that during my stay at the Gulf Islands Film & Television School, a GIFTS supervisor or mentor must be aware of where I am at all times. I understand that for my own safety, I must have a supervisor or mentor’s permission, and fill out the STUDENT SIGN OUT SHEET (posted in the kitchen) before leaving the premises. I will respect these rules under all circumstances.
Agreed by (Student or Parent Name):*
FirstLast
Video Release Agreement*
I hereby irrevocably grant the Gulf Islands Film & Television School (hereby referred to as GIFTS) a non-exclusive right to use any work created by me while in attendance at GIFTS for purposes which shall include, but not be limited to: Festival screenings, screenings at educational institutions, webcasting (via internet or other networks), broadcasts (television, cable, etc.), GIFTS promotion and marketing, archiving & video cassette sales. Further, I grant GIFTS the right to edit, modify, remix and otherwise alter the work created for the purposes stated. In consideration of the grant of these rights, GIFTS shall properly credit me for all creative work. I agree that I will immediately inform GIFTS if I am aware of any commercial distribution of any work produced at GIFTS by me. I also agree to share equally any proceeds derived from distribution of such work with the other students credited with production of the work. Finally, GIFTS shall remit any net profits earned from the use of the work created at GIFTS to the Access to Media Education Society or an equivalent not-for-profit organization for the sole purpose of providing bursaries to other worthy candidates to attend GIFTS programs. The sufficiency of this consideration is agreed by me.
Agreed by (Student or parent name):*
FirstLast