Consent Form for Minors

Consent Form for Minors

Once submitted, you will receive a copy of this consent form to the email you provided.

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Student's Name *

First

Last

Student's Email *

Date of Birth *

Semester Registered *

Guardian Name *

First

Last

Relationship to student *

Email Consent Relationship

Guardian's Email *

Guardian's Phone Number *

Emergency Contact (if different than guardian's)

Participation Consent *

• I am the parent or legal guardian of the student named above, and I give permission for them to attend and participate in the Korean language classes and events with NSKo, the Nova Scotia Korean Language and Culture Centre. I understand that these classes are regularly located at the Halifax Central Library, but that they are not part of Halifax Library’s programming. I understand the program is run by volunteers, including the teachers, and is free of charge other than a refundable deposit.

Photo & Video Consent *

• Yes, I give permission for my child to appear in photos and video used for these purposes.
• No, I do not give permission. My child should not be photographed or filmed.

Privacy *

• I understand that the information on this form is collected only to run the program and contact you in an emergency. It is shared only with program volunteers and potentially Halifax Library staff as necessary.

Guardian Signature *

Clear Signature

Submit