QPRC Youth Services - Permission Note - Library After Dark Games Night

If you are aged between 11-16 join us for pizza, games and activities at the Libraries After Dark Games Night!

Friday 30 May from 5-7:30 pm at the Queanbeyan Library, 257 Crawford Street.

Child Name (Given and Family names) *

Child's age *

How would you describe your child's gender?

Boy or maleGirl or femaleNon-binaryThey use a different termPrefer not to say

What term do they use?

Do they identify as an Australian Aboriginal and/or Torres Strait Islander person?

NoYes, AboriginalYes, Torres Strait IslanderYes, both Australian Aboriginal and Torres Strait IslanderUnsurePrefer not to say

Dietary requirements or allergies

Any medical conditions or behavioural concerns?

Address *

Street address *Street address line 2

Town/Locality *

State

Postcode

Country

Parent/Guardian (Given and Family names) *

Parent/Guardian Mobile Number *

Parent/Guardian Email Address *

Parent/Guardian signature *

Draw signature|Type signatureClear

I give permission for the child listed above to participate in the Queanbeyan-Palerang Regional Council’s Library After Dark Games Night, under the supervision of Council’s Community Team. I understand that if my child leaves the event premises, they are no longer under the supervision of QPRC staff. *

I give permission for Queanbeyan-Palerang Regional Council to use photographs/videos including the child under my care in documents produced by and for the Council. The footage and images may be used on Council webpages (including www.qprc.nsw.gov.au), social media accounts, and to share these photos/videos with media/news outlets.

If you have any questions please email community.team@qprc.nsw.gov.au

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