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Choreographed Fights & Physical Stunts
Students: Read and Complete This Entire Form
GENERAL INSTRUCTIONS:
Use the TAB key or MOUSE click to move from field to field.
CAUTION: Using the ENTER key will automatically submit the form.

PLEASE REVIEW YOUR SUBMISSION BEFORE CLICKING "SUBMIT"
Distribution of Certificates
This is a SPECIAL INSURANCE REQUEST, it may take an additional one to two weeks to process your insurance, so start early.
PLAN ACCORDINGLY!!
GENERAL PRODUCTION INFORMATION

Have you submitted the "Production Registration Form"?:
Yes  No

If you answered "No" this will redirect you to the proper Production Registration Form.

Original Name of Production:

Director's Name (No nicknames. List name as registered with NYU!):
First Name:
Last Name:
Insurance Contact - Email Address:
Email address must be an NYU issued email.
Must end in @nyu.edu. All others will be rejected, and your form will have to be resubmitted.

Please Provide a Detailed Description of the Shoot:


List Stunts by Type, Location and Date:


Describe Safety Measures Used to Protect Participants, Public and Equipment:


Who is Employer of Record of Person(s) Performing Stunt(s):

How Many People Involved in Stunt Scene?
Provide a Bio/Resume for Each Stunt person, including Stunt Coordinator:

If you want to Deliver or Fax this Bio/Resume you can.
Fax it to: (212-995-3555)
or Deliver it to: 838 Broadway, 4th Floor.
Please include your Production Name, and Director Name, on cover sheet!
You MUST put "Will Fax" or "Will Deliver" in box above,
if Fax or Email option is selected.

Note: We recommend that you advise your Equipment Vendor about how the Equipment will be used in the Stunt, e.g., taken into hazardous environment, camera taken down waterslide, etc. Any recommendations that are suggested by the Vendor to protect the Equipment, must be adhered to, to insure proper care.

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