Release Form

Date:
Dear Sir/Madam,
This release form is to confirm our agreement as follows:
a) You grant permission for our production crew to record at Queen
Marys hospital on the terms that have been agreed.
b) You grant permission for us to record the doctors/nurses working at
Queen Marys Hospital and use the footage in our coursework.

c) You agree that the period of recording will be between

/12/14
/12/14. Any extra days needed will be arranged and approved
before filming.

d) All hospital equipment used by/in possession of our production crew

will be treated with great care and vigilant behaviour.

Yours faithfully
Renata Pereira, Richard Fashola, and Malcolm Shodeinde

Signed by Production crew

Renata Pereira

____________________________________

Date:

Richard Fashola

____________________________________

Date:

Malcolm Shodeinde

____________________________________

Date:

Signed by hospital
______________________________________________________

Date: