SRC Casual Participant

Child’s name [first and last] *

Parents’ name [first and last] *

Library card number *

Has your child attended any APL Programs before (rhymes and songs, ect.) * Yes No

Birth Date *

Phone Number *

Emergency contact number and relationship to participant *

Email *

School name (entering in the fall) *

Grade your child just completed *

Programs your child would possibly attend (please choose ONLY ONE based on your child’s age and grade) * SRC Kindergarten Program (for participants who will be entering KINDERGARTEN in the fall) Wednesday 9:30-10:15am SRC K-Gr.1 Program (for participants who have just completed KINDERGARTEN or GRADE 1 Tuesday 9:30-10:30am AND/OR Thursday 11:30-12:30pm SRC Gr. 2-3 Program (for participants who have just completed GRADE 2 or GRADE 3 Tuesday 11:30am-12:30pm AND/OR Thursday 2:00-3:00pm AND/OR Friday 11:30am-12:30pm SRC Gr. 4-5 Program (for participants who have just completed GRADE 4 or GRADE 5 Tuesday 2:00-3:15pm AND/OR Wednesday 11:15am-12:30pm AND/OR Thursday 9:30-10:45am SRC Gr. 6-7 Program (for participants who have just completed GRADE 6 or GRADE 7) Wednesday 2:00-3:30pm AND/OR Friday 2:00-3:30pm

Liability Release – The information on this form is collected under the authority of the Libraries Act and section 33(c) of the Freedom of Information and Protection of Privacy Act. The information will be used to provide you with library services and to maintain statistics. If you have any questions about the collection of this information please contact Lucia Gomez @403-948-0600 ext. 8381. I ______________________, herby 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 Marigold Library System or the Airdrie Public 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 clear understanding that he/she does so entirely at his/her own risk. (Must tick box to proceed). * Agree

Photo Release - My child’s picture may be taken during the Summer Reading Program. Photos may be posted in the program room, displays in the library, in our Newsletter, on the Airdrie Public Library website, or other promotional materials for the Library. As well, the Airdrie Echo and City View may periodically take pictures that may appear in the local newspapers. * Yes No

Initial to confirm Liability and Photo Release *

Unattended Child Policy- Please be aware that Airdrie Public Library’s Unattended Child Policy applies to all participants in the SRC. Please review the policy at https://www.airdriepubliclibrary.ca/About-Us/Library-Info/Policy/Policy/Unattended-Child-Policy (link also above), and check the appropriate box below. * My child is between the ages of 4-8 and I, or another appropriate guardian, will remain in the library at all times My child is aged 9 or older and myself or the designated emergency contact person provided will be available by phone while my child is attending the program.

If your child’s guardian is a minor between the ages of 13-18, referred to as a temporary caretaker, please read and fill out the form at: https://www.airdriepubliclibrary.ca/Forms/Airdrie-Public-Library-UNATTENDED-CHILD-POLICY-TEMPORARY-CARETAKER-CONSENT-FORM (Link also above), and click below to confirm you have submitted it. Yes, I have submitted the temporary caretaker form.