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75 Maple Street
Summit, NJ 07901
908.273.0350

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Teen After Hours Permission Slip

Dear Parent/Guardian,

In order for your child to participate in “Summer Reading, Had Me a Blast” After-Hours Teen Summer Reading Finale on Friday August, 17th from 4:45 to 6:00pm, you and your child must read and sign this permission slip and return it to the library prior to August 16th at 9:00pm.

Participants must be entering 6th grade or higher in the Fall 2018 to attend the program.

All attendees must be in the building prior to 5:00pm. Late arrivals will not be admitted. Youth Services Librarians Ms. Jenna Ingham and Ms. Ann-Marie Aymer will be on-site during the program. The program will end at 6:00pm. Participants may only leave early only if prior arrangements have been made. Attendees must be picked up no later than 6:30pm.

CONSENT FORM AND LIABILITY WAIVER

By signing this form, I give permission for my child to attend the “Summer Reading, Had Me a Blast” After-Hours event at the Summit Free Public Library. I assume all responsibility for injury to my child, and for injury which my child may cause to others. I agree to hold harmless the Summit Free Public Library and all library staff from any and all damages and causes of action either at law or in equity, which I or my child may have as a result of participation in or attendance at this activity sponsored by the library.

IN CASE OF MEDICAL EMERGENCY

By signing this form, I give permission for the supervising adults at Summit Free Public Library to contact 911 for medical assistance for my child/ward named above, and consent to medical treatment as deemed necessary by emergency medical personnel. I will be contacted immediately if any emergency arises.

BEHAVIOR

By signing this form, I agree that my child and I understand that violations of Summit Free Public Library’s behavior policy or the enjoyment of others at this event will result in eviction. I agree to be available at the contact number I will provide.

Name of Attendee:(*)
Name of Attendee:

Grade in September(*)
Please enter child's grade in September

Parent or Guardian Name(*)
Parent or Guardian's Name

Relationship to Child(*)
Relationship to Child

Address
Address

Phone(*)
Phone

EMail Address
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Food and refreshments will be provided throughout the night. Please list any food allergies, sensitivities, dietary requirements, or medications:
Food Allergies

 

Dear Parent/Guardian,

In order for your child to participate in “Summer Reading, Had Me a Blast” After-Hours Teen Summer Reading Finale on Friday August, 17th from 4:45 to 6:00pm, please print this page, sign it, date it, and bring it back to the "Ask Us" Desk in the Youth Services Department.

Please also click the submit button at the bottom of the screen to send your information to Ms. Aymer and Ms. Ingham. In case you have problems with printing this form, a copy of this page will be sent to you via email as well.

Parent/Guardian Signature:

_____________________________________________

Date: _______________

For Attendee:

By participating in “Summer Reading, Had Me a Blast” After Hours Teen Summer Reading Finale event I agree to respect the library, my fellow program participants, and library staff. I will follow staff instructions and agree to abide by library rules.

My parent/legal guardian and I both understand that if there are any issues, library staff may contact my parent/guardian to pick me up at any time during the event.

Inappropriate conduct includes but is not limited to:

  • Threatening, offensive or abusive language and behavior
  • Harassment of employees or other participants
  • Misuse or defacement of library facility or materials

Print Name: ______________________________________________

Signature: _______________________________________________

Date: ___________________

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