Student Media Crew Application

Name *

First Name

Last Name

Do you have access to vehicle? If no, do you have another form of reliable transportation that will help you arrive onetime for shoots and leave on time afterwards? *

Yes, I have access to a vehicle.

Yes, I have access to a form of reliable transportation.

No, I do not have access to a vehicle or a reliable form of transportation.

I understand that any photograph, video, or other from of media that I capture of a Lincoln Park Performing Arts Center performance is the sole property of Lincoln Park Performing Arts Center. I will neither keep any media nor give any media away to anyone without prior express consent of the Marketing Team of Lincoln Park Performing Arts Center. *

Yes

No

I understand that I will be held to the same, if not higher, standard of COVID safety as the actors involved in the productions I will be photographing/recording. This includes but is not limited to: Proper masking, completion of PCR tests to be delivered to the COVID Compliance Officer, Covid compliance forms, refraining from integration with the cast and going backstage, and the like. *

Yes

No

At this time, have you received a COVID-19 vaccination? *

If selected, proof of vaccination will be required before the start of events for everyone not exempt by age (you are under 12 years of age) or disability or religious reasons in accordance with the ADA and Title VII.

Yes, I have been fully vaccinated against COVID-19

I have received a single dose of the COVID-19 vaccine and waiting to receive my second dose.

I have not received the COVID-19 vaccine.

Choose not to disclose

By clicking 'Yes,' I attest that my answers are accurate to the best of my knowledge. *

Yes

Privacy Statement - THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED. PLEASE REVIEW IT CAREFULLY. How We Collect Health Information About You: Lincoln Park and its designated employees collect health information that is necessary to ensure the safety and health of all its students and employees. This data may be collected through a variety of means including but not necessarily limited to the submission of electronic forms and verbal communications. Information is only used as is reasonably necessary. Health information you provide Lincoln Park directly or indirectly is held in strictest confidence. What We Do Not Do With Your Health Information: Lincoln Park will not save creative team/crew/cast member's health information beyond the specific project they are working on at the time this form is completed. Information will only be shared as relates to safety within the work space and will not be sent to anyone beyond the designated safety employee(s). This information could also be used in the event that Lincoln Park needs to do contact tracing if a creative team/crew/cast member were to test positive. *

I have read and understand the above statement.

Acknowledgment - Nothing contained herein is intended to revoke or repeal any student rights. Nor are they a substitute for any existing safety and health-related regulatory requirement. *

I acknowledge the above statement.