Library Lounge Registration

Join the new after-school program “Library Lounge” at QPRC Libraries, 257 Crawford Street, Queanbeyan. The programs run on Tuesday afternoons at 3:30 pm – 4:30 pm during school terms. The program commences on 12 November 2024.

Please complete one form per child/young person.

We are also asking some demographic questions. This information will help us better understand your child’s needs and how we can help address them.

All information provided will be kept strictly confidential.

A staff member from the Community Team will be in contact to confirm your child's spot for the term.

Family Details

Child's first name *

Child's last name *

Child's date of birth *

Gender *

Address *

Street address *

Suburb/Town/Locality *

Country of birth *

Main language spoken at home *

Is the child of Aboriginal and/or Torres Strait Islander origin? *

Does the child have any allergies or dietary requirements? *

YesNo

Please tell us about the allergies or dietary requirements *

Are there any other support needs or requirements that would be helpful for us to know about? *

YesNo

Please tell us about the support needs or requirements *

How is your child getting home at the end of the session? *

They will be picked upThey will make their own way home

Parent/Guardian details

Parent/Guardian (Given and Family Names) *

Parent/Guardian email Address *

Parent/Guardian mobile number *

Permission/Consent

I give permission for Queanbeyan-Palerang Regional Council to use photographs/videos including the child/young person under my care in documents produced by and for the Council. *

YesNo

I give permission for my contact details to be added to the Youth Activity Updates mailing list. Queanbeyan-Palerang Regional Council will send updates about school holiday activities, programs, events, and other offers for youth in the area. *

YesNo

We are using an IT system called the ‘Data Exchange’ to store your child’s information. This system is hosted by the Australian Government Department of Social Services (DSS). You do not have to consent to sharing personal information with DSS. If you do not consent to us sharing personal information, it will not affect the services you receive. If you do consent to sharing personal information with DSS, you can ask for this information to be removed at any time.

DSS de-identifies your data. This means they remove information that identifies you or that could be used to re-identify you (e.g. your name). DSS combine your data with other clients’ data in the Data Exchange to identify trends at the program level. This information is used to develop policy, administer grants programs, and conduct research and evaluations. DSS may use this data to produce reports. These reports may be shared with other organisations. The data in these reports is de-identified.

You can find more information about how DSS will manage your personal information in the DSS privacy policy on their website: https://www.dss.gov.au/privacy-policy.

Do you consent to:

Information on this form to be stored on the Data Exchange? *

YesNo

I would like a copy of the Department of Social Services Data Exchange “Information on Privacy” form *

YesNo

Parent/Guardian signature *

Draw signature|Type signatureClear

By submitting this form you agree to your personal information being collected and stored by QPRC for the purpose of providing this program.