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`Olelo: The Corporation for Community Television

Program Submission Form

One Form per Program

Program/Series Title:

Episode Title:

Cablecast Date:

Funded by an `Olelo Production Grant __ Yes __ No

Is this Program Time Sensitive __ Yes __ No If yes, explain why :


Is this program produced with `Olelo facilities? __ Yes __ No

This program is scheduled on: __ ATTN __ TEC __ VIEWS

Program Description (60 Characters or less including spaces):

___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___
___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___
___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___

If Live, indicate which studio:

1. I am thoroughly familiar with the content of the program material submitted for cablecast and agree that it complies with applicable federal and state statutes and regulations with regard to cable programming. The program does not contain any material which is obscene; is intended to

mislead or obtain money by false or fraudulent pretense; is related to any lottery or similar scheme offering prizes dependent upon chance; improperly invades the privacy of a citizen or puts someone in a false light; is libelous or slanderous; violates any copyright or trademark of any third party; contains any direct appeal for funds, support or property of value; promotes, endorses or refers to any business, service or product for which economic consideration was received; and/or designed or intended to promote the sale of commercial products, trade or services.

2. Program contains matter designed for adults only. (Please check either yes or no)

____ Yes ____No (This will not necessarily pre-empt program from airing.)

3. I have obtained all approvals, clearances, licenses, etc. which are needed for the Program.

This includes, but is not limited to approvals by broadcast stations, networks, sponsors, music

licensing organizations, copyright owners, performers' representatives, all persons appearing in or referred to in the program material, and any other approvals that may be necessary to cablecast the Program.

4. I have paid, or will timely pay, all financial obligations (including residuals, union fees, license fees, etc.), owed to third parties in connection with the creation and cablecast of this Program.

5. I agree to indemnify and hold harmless The State of Hawai`i, Oceanic Cablevision, Inc.,

Chronicle Cablevision of Hawai'i, `Olelo: The Corporation for Community Television and their

agents, employees and representatives from any and all liability and injury (Including reasonable

fees and costs incurred in defending claims) arising from, or in connection with the Program,

including but not limited to: alleged violations of the laws, rules, regulations or other requirements of local, state and federal authorities; claims of libel, slander, invasion of privacy, or the infringement of common law or statutory copyright; claims for unauthorized use of any

trademark, trade name or service mark or the like; alleged breaches of contractual or other

obligations owing to third parties.

6. I recognize that `Olelo has not, and will not, endorse or approve the Program and that `Olelo will not waive any of its rights even if it reviews the Program before it is broadcast. I also

understand that false or misleading statements made on this application are grounds for forfeiture of the privilege to use `Olelo production equipment, facilities and access channel(s).

7. I have read and am thoroughly familiar with the rules and procedures for the use of `Olelo's

transmission services and agree to abide by them. I hereby grant `Olelo permission to reproduce

and transmit the program at `Olelo's discretion: (a) if any portion of the Program was created

using `Olelo production equipment or facilities, `Olelo may air the program for a period of three

years with unlimited scheduling; (b) if the Program was not created with `Olelo production

facilities, `Olelo may air the program for one month with unlimited scheduling.

8. I agree that any damage or loss to the program matter submitted by me even though due to

negligence or other fault of `Olelo, its agents, employees, representatives and affiliates will only

entitle me to a like amount of blank videotape. Except for such replacement, the acceptance of

videotape is without other warranty or liability and recovery for any incidental or consequential

damages is excluded.

9. I understand that the following information will be made available to the public in connection

with the program.

Please provide all information required below:

Signature: _________________________________________________________

Producer/Presenter: __________________________________________________

Mailing Address: ____________________________________________________

Day Phone: ________________________________________________________

Evening Phone (only if applicable): _______________________________________

Organization: ________________________________________________

Org. Phone:_________________________________________________


For Office Use Only:

Date Received: ___________

Staff Initials: _____________

Playback Tape ID #: ____________

Edited Master Tape ID #: _____________

Return to: `Olelo: The Corporation for Community Television

1122 Mapunapuna Street, Honolulu HI 96819

Voice: (808) 834-0007

Fax: (808) 836-2546