Reading Dogs Registration form

Child's Name*

First NameLast Name

MaleFemale

Date of Birth*

Date

Address*

Mother*

NamePhone Number

Father*

NamePhone Number

Contact Email Address*

example@example.com

Emergency Contact*

NamePhone Number

How did you hear about the program?*

Photography and Filming Consent

In accordance with our child protection policy, we will not permit photographs, videos or other images of young people to be taken without the consent of the parents/carers and the child.

The Developing Child Centre will follow the guidelines for the use of photographs and videos.

The Developing Child Centre will take all steps to ensure these images are used solely for the purposes they are intended for. If you become aware that these images are being used inappropriately you should inform The Developing Child Centre immediately.

As parent/guardian of the named child, I give permission for group and individual photos and/or filming to be taken during the event and understand that these may be used for archive and publicity purposes.

By signing the form:

I can confirm that I have read, or been made aware of, the organization’s photography and videoing policy.

I can confirm that I have read, or been made aware of how the organization will use these images or videos in the future and how these images or videos will be stored within the organization.

I authorize the use of photos and information to be published on the official Developing Child Centre website/social media.

I understand that The Developing Child Centre will make sure all measures will be taken to ensure a safe environment, I am fully aware of the dangers and risks inherent in participating in this activity. Being fully aware of the risks.

I understand that I need to sign the attached participation form and return to TDCC Reception on or before the session, if my child has been selected to participate the program.

Name and Signature*