Summer Reading Club Forms

Participant’s Name: _________________________________________ Participant’s Age: _____
Phone #: ________________________ Address: ______________________________________

In keeping with FOIP (Freedom of Information and Protection of Privacy Act) the legislation of St. Paul Municipal Library requires that all participants of its program under seventeen years of age to receive parental permission to:
1. Have their photographs, names and/or stories published in the local/regional newspapers.
2. Display their work at the library.

I, __________________________________ parent/guardian of __________________________
Age _____ give my permission for the items checked above.
By signing this release form, I document with my signature that I have read, understand, and completely agree with its conditions
Parent/Guardian Signature _______________________________________________________
Date ________________________________________________________________


Participant’s Name: ______________________________________ Participant’s Age: ________
Health Care #: ___________________________________________Phone #: _______________
Parent/Guardian’s Name: _________________________________________________________
Emergency Contact: ________________________________ @ Phone #: ___________________
If your child is under the age of 10 years, please indicate who other then you may sign-in when dropping off and sign-out when picking up your child.
Please indicate any allergies, or health conditions that you feel the library staff should be aware of, such as specific foods and/or physical activities that may adversely affect the health of your child.
• I, ____________________, hereby acknowledge the risk of injury inherent in the Summer Reading Program activities. I hereby consent and agree that I shall not make any claim for injury or damages whatsoever against the Northern Lights Library System or the St. Paul Municipal Library Staff, its board members, or its volunteers, while my child takes part in the program. I agree that my child will be participating in the activities of the Summer Reading Program upon the clear understanding that he/she does so entirely at hi/her own risk.
• The St. Paul Municipal Library reserves the right to refuse of terminate participation at any time with just cause
• By signing this waiver form, I document with my signature that I read, understood and completely agree with the conditions.

“The information on this form is collected under the authority of the Libraries Act and the Freedom of Information and Protection of Privacy Act. The information provided will be used to administer the Summer Reading Program, calculate administrative statistics and provide information on library programs. If you have any questions about the collection and use of the information, please contact the St. Paul Library @ 780-645-4904.”

Parent/Guardian __________________________________________ Date