EmailMe Form - Drone Shoot Permission Form

Name *

First Last

Email *

Address *

Street Address City State / Province / Region Postal / Zip Code

Date and Time of Shoot *

MM / DD / YYYY

Provide a flight plan of where the drone shoots will occur on campus and how the footage will be used. *

Insurance Company *

This is required in case any damage is done to any campus property due to the drone shoot.

Insurance Company Phone *

### - ### - ####

Please submit a copy of the declarations page from your insurance company. *

NOTE: The Marketing & Communication Office may contact you for permission to use your footage for marketing purposes. Depending on the quality of the video, they may offer a stipend for such use.

Please check if you agree. *

I am a Part 107 licensed pilot.

Please submit a copy of your license. *

Please check if you agree. *

I agree to hold Wartburg College harmless for any damages or personal injury that may occur during the drone shoot.

Please check if you agree. *

I understand I will be held responsible for any damage to college property or personal injury caused by the drone shoot.

Please check if you agree. *

I have researched and received all legal permission from any aviation authorities, if such permission is required.

Signature *

Clear