Animal and Veterinary Service

Request to Film in the Vivarium

Version 7/31/12

Restricted Access Policy
Requesting Access to the Facility
Requesting Animal Holding Space at the Facility
Request to Film in the Vivarium
Visitors to the Vivarium
Hours of Operation
12 Hour Rule

Persons requesting to film must agree that all animal activities (if applicable) to be filmed will be done in conjunction with their approved UH IACUC protocol for the purposes specified within it, and not for the sole purpose of demonstration for filming. He/She must agree not to include any identifying landmarks such as room numbers, researcher names, or animal/protocol information.

Principal Investigator's Name: Date:
Contact Information:

PI Email:

Phone: Mobile:

UH IACUC Protocol Number used for Filming:

Describe all aspects of activities to be filmed in the vivarium. Animal activities require IACUC approval:

Date(s) and Time(s) of Filming:

Filming will take place in:
Building(s) Room No(s).

Name of Filming Company:

Name and Contact Information (cell and email) for Filming Company

I agree that all animal activities (if applicable) to be filmed will be done in conjunction with my approved UH IACUC protocol for the purposes specified within it, and not for the sole purpose of demonstration for filming.
I agree not to include any identifying landmarks such as room numbers, researcher names, or animal/protocol information.

Please check one of the following regarding the preceding:

I Agree I Disagree Name: Date:

*AVS assistance over 2 hours per month may result in a Special Service charge back. Service charges include AVS staff member's time consulting with attorneys as it relates to the film licence and staff member's time to prepare the location for filming. Please refer to www.hawaii.edu/technicalservices.html.

Please review the form for completeness before submitting.