PARENTAL CONSENT FORM
For: Game Night Lock-In
7:00 PM-11:59 PM August 5th
The Game Night Lock-In at the Library will be held on August 5th, 2016 from 7:00 PM-11:59 PM. The event will consist of gaming on the XBOX 360, XBOX one, NES, Wii U, and the computer. Parents should be aware that some of the games are rated M for Mature due to fantasy violence and/or blood and that a separate form will need to be signed in order for children to be allowed to play those games. However, also be aware that we strive to keep a friendly and enjoyable environment during our library events and any M rated games will be played in a separate room away from the general group and under adult supervision. There will be general gaming as well as challenges and tournaments attendees will be able to participate in.
All children below the age of 18 must submit this completed and signed consent form to the library prior to the event on August 5th, or present the form at the door at the event. No one under the age of 18 shall be permitted to attend the event without a completed and signed consent form. Those over the age of 18 will be required to show ID to be able to enter the event. Furthermore, we will be enforcing a strict age limit of 10 years old; no individuals younger than 10 will be permitted to stay at the library for this after hours activity.
Library staff will lock the doors at 9 PM, after which no one shall be permitted to enter the building without having made special arrangements prior to the event. Special arrangements must be submitted in written form before the event begins at 7 PM. Furthermore, after the doors are locked, no child under 18 shall be permitted to leave the library without a parent arriving to pick them up and sign them out. Parents must provide identification to library staff in order to remove their child from the event. The event ends at midnight, parents are expected to arrive to pick their children up from the event no later than 11:59 PM on August 5th, 2016.
Snacks and drinks will be provided.
Name of Child: ____________________________________________________
Child’s Birthdate: ____/____/____
By filling out this form and signing on the indicated line below, you do hereby grant permission for the above child to attend the Game Night Lock-In at the library. You also recognize that in the event that your child becomes disruptive or is otherwise unable to remain at the library for the entirety of the night, library staff will contact you and have you bring the child home. Please keep your phone nearby in the case of this occurrence or any other emergency.
The library has a no bullying policy as well as no tolerance for disrespectful or inappropriate activity. In order to maintain a safe and pleasant environment for all of the people in attendance at the Game Night Lock-In, any children engaging in the aforementioned activities will have parents contacted, be asked to leave immediately, and will not be permitted to return. Please ensure your child understands this.
Please note that only persons listed below and carrying a valid photo ID will be allowed to pick your child up from the library
Parent’s Name: ___________________________________________________
Person authorized to pickup your child: _____________________________________________
Parent’s Signature: ________________________________________________
Phone Number: ____________________________
Emergency Contact #1:______________________________________________________ Phone Number: ________________________
Emergency Contact #2:______________________________________________________ Phone Number: ________________________
We look forward to the Game Night Lock-In at the library! Should you have any questions or concerns please contact Holly by phone at 208-237-2192 or by email at firstname.lastname@example.org.
Please list below any allergies or special needs your child may have during their stay at the library: