NYRP Community Garden Filming Request Form

Community Garden Media Permit Request
This is the form to request permission to use a New York Restoration Project community garden for commercial or non-commercial filming, photography, or recording. Completion of this form does not guarantee approval.
Requester Information
Individual/Group/Company Name:*
Primary Contact Name:*
Email:*
example@example.com
Phone Number:*
Format: (000) 000-0000.
Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Press/media inquiry (news organization, feature story, editorial)Commercial (profit-generating, advertising, corporate)Documentary/independent projectEducational/student project (course requirement, academic research)Other

Project Details
Project Summary
Working title of project:*
Brief description of content and plot/concept:*

0/0
Number of cast and crew (Total people on site):*
Front Gate/EntranceGarden BedsTool ShedShade Structure/PergolaStagePathwayLawnOther

Project Details
Footage Usage
How will the final footage be used/distributed? Select all that apply and describe.*
YesNo

Clean-up & Environmental Impact
The garden must be left in its original state. All trash must be removed from the site. Describe your plan for clean-up:*
YesNo
Please describe these elements:

Community Garden Media Permit Request