Summer Registration 2022 Child's Name Child's Age Parent/Guardians Name Emergency Contact Emergency Contact Phone Number Parent/Guardian Risk of Injury Acknowledgment I, (Parent/Guardian) hereby acknowledge the risk of injury inherent in teh summer reading program activities. I hereby consent and agree that I shall not make any claim for injury or damages whatsoever against Tofield Municipal Library, it's staff, board, members, or its volunteers while my child takes part in the program. I agree that my child will be participating in activities of the summer reading program upon the cleat understanding that he/she does so entirely at his/her own risk. Agree Disagree Allergies Please indicate any allergies or health concerns that you feel the library staff should be aware of, especially if special foods, and/or physical activities may adversely affect the health of your child. FOIP (Freedom of Information and Protection of Privacy Act) In keeping with the FOIP act the Tofield Municipal Library requires that all program participants under 17 years of age have parental permission to: 1. Have their photographs, names, and/or stories published in the local/regional newspaper. 2. Display their work at any branch of the Northern Lights Library System. I (parent/guardian) give permission for his/her photograph, name, and/or stories to be published in the local newspaper and for his/her artwork to be displayed while participating in any Northern Lights Library System Program. Agree Disagree Parent/Guardian Signature Date Leave Blank
