IYG Application – Part 2: Parent Guardian Section

    Student Applicant Name:

    School Name & Location:


    Section 1: PARENT/GUARDIAN CONSENT TO STUDENT PARTICIPATION

    Parent/Guardian Name:

    Parent/Guardian Email Address:

    Parent/Guardian Address:

    Best phone to reach you:

    Next best phone to reach you:

    Alternate Emergency Contact (not parent or guardian):

    Name:

    Best phone to reach you:

    Relation to Applicant:

    Next best phone to reach you:

    PERMISSION TO PARTICIPATE

    I affirm that I am a parent/guardian of the above-named student applicant. YesNo

    I grant permission for my student applicant to participate in this year's Indigenous Youth Gathering organized by WISE NL. YesNo

    Your Name:

    Date:

    Section 2: PARENT/GUARDIAN IMAGE AND RECORDINGS RELEASE


    I authorize WISE NL to use:

    • Photographs (both individual and group) in which my child may be identified by name.

    • Sound recordings of my child

    • Interviews of my child

    • Printed material written by my child

    For use in:

    • Promotional initiatives such as website, reports and other WISE NL programs and brochures
      for WISE NL and Memorial University of Newfoundland.

    • Media releases such as paper, newsletters, magazines, etc.

    I agree not to hold WISE NL responsible for the content of such photographs, sound recordings or interviews or the specific use to which they may be applied. I understand I have the right to refuse to grant this authorization now or to revoke authorization at any time. Compliance is voluntary. Consent remains valid until withdrawn.

    By clicking the "Yes" box below, you agree to the above conditions regarding image and recording release.
    Yes, I give consent.No, I do not give consent

    Your Name:

    Date:

    What's Next?

    • After clicking on the "SUBMIT" button, this information will be sent to the IYG organizers and a copy emailed to you.

    • The information is not otherwise retained on our website. Once the email is received by the IYG organizers, the information is considered confidential.

    • If you wish to change any information, follow the instructions in the acknowledgement email.

    Go back to Applications.