Consent form Consent Form Programme Consent Form Consent and permissions for Christchurch City Libraries programmes for children. * indicates a required field I give consent for my child (full name) * Required First Last Are you submitting this form for an individual programme or a school programme? * RequiredSchoolIndividualTerms of student participation * RequiredTo support us in providing a safe learning environment, please discuss the following safety guidelines with your child before you submit this consent form. I have discussed the safety guidelines with my childDate of Birth * RequiredLibrary Card Number (if a member)Parent / Guardian Agreement I give permission for my child to participate in Christchurch City Libraries programmes. I understand that: My child may be asked to use an existing personal email account, use a temporary email account provided by Christchurch City Libraries or be asked to create an email account to enable access and use of web tools for learning; My child may be asked to work outside within the boundaries of the library grounds; Christchurch City Libraries may contact me about programmes.Parent / Guardian's full name * Required First Last Parent / Guardian's phone number * RequiredEmail Emergency contact's name * Required First Last Emergency contact's phone number * RequiredPrivacy Policy By submitting your personal information, you acknowledge that your information will be collected and processed by Christchurch City Libraries in accordance with its Privacy Policy. Your information will only be used and disclosed for the purpose of Christchurch City Libraries programmes. Consent * RequiredBy clicking this box, I confirm that I am the parent/legal guardian of the child named above and that I give permission for my child to participate in the Christchurch City Libraries Programme on the basis set out in this consent form. I agreeModel ReleasePhotographs and film of children may be taken and these and their work may be used in marketing material for Christchurch City Libraries.I agree to photographs, video, or social media posts of my children and their work * RequiredI agree to photographs, video, or social media posts of my children and their work appearing on Christchurch City Libraries or Christchurch City Council channels. YesNoModel Release Form I hereby irrevocably grant to the Christchurch City Council and its assignees the full right and permission to use my photographic image in any form of media or for any other lawful purpose in relation to any promotion or communication relating to the Christchurch City Council or its activities or to any organisation that the Christchurch City Council funds, sponsors or supports in any way. I understand and agree that my photographic image may be cropped, altered, transformed or reproduced in any way and may also be combined with other works or text or sub-licensed to third parties for use. I also understand that my photographic image may be entered into photographic competitions or awards, used on advertising or otherwise used to promote the Supplier’s business, and/or submitted for display at art galleries. I waive any right (including all legal rights) in my photographic image that I may have to inspect or approve any product or copy of my photographic image or any related work prior to its use. I am legally entitled to authorise this use and have read and fully understood the above authorisation. Name * Required First Last Date - must be mm/dd/yyyy format * Required Date Format: MM slash DD slash YYYY Address * Required Street Address Address Line 2 City Postcode Country AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarrussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe PhoneAge * RequiredBy clicking this box, I confirm that I am 18 years of age or over and that I have read this release, understand and agree to the terms and conditions of the model release form set out above.By clicking this box, I confirm that I am the parent/legal guardian of the individual named above and I have read this release, understand and approve of its terms.NameThis field is for validation purposes and should be left unchanged. 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