Exmouth Library Drop-in Session Permission Form

The Shire of Exmouth is re-open to visitors

Exmouth warmly welcomes visitors following Tropical Cyclone Narelle and encourages those wishing to visit the region to book ahead. More information: Cyclone Narelle Recovery Information Page

Shire facilities re-open

Shire Facilities are now open following the impact of Tropical Cyclone Narelle, the Spray Park remains closed for further repairs.

Exmouth Library Drop-in Activities Permission Form

The after-school Drop-in program allows students to use the library facilities, laptops and accessories to work
independently.

Please fill in the following permission form for each child attending the Drop-In sessions at the Exmouth Public Library.

Childs First Name*

Child's Last Name*

Are you a parent or guardian?*

Parent/Guardian first and last name*

Parent/Guardian mobile number*

Parent/Guardian email*

Emergency Contact First and Last Name (must be different to above parent/guardian)*

Emergency Contact Phone Number*

I give permission for my child to attend Exmouth Library without adult supervision for the drop in sessions. I accept full responsibility for any materials my child accesses whilst using the internet. I understand that if my child is not conducting themselves in a respectful and appropriate manner to staff and other patrons, or is mis-using library equipment, that I may be contacted to pick up my child and they may no longer able to participate in the drop-in program.*

YesNo

For Students: I will keep my passwords private and not share with other students; I will behave in a manner that is respectful to library staff and patrons; I understand that I am solely responsible for all activity on the internet; If I find any information that is inappropriate or makes me feel uncomfortable, I will tell a library officer; I will not damage or disable the computers, accessories, computer systems or computer networks of the library; I will not try to access internet sites that have been blocked by the library or Shire of Exmouth.*

YesNo

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