Exmouth Library Drop-in Session Permission Form

Cyclone Advice

‍An incident is active but there is no immediate threat to lives or homes. Be aware and keep
up to date.

Emergency alerts at Emergency WA

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

Welcome to the Shire of Exmouth

General Office:

Address