Program Consent

This is a form to be filled out and signed by a parent / guardian of a youth attending a program at The MacPhee Centre for Creative Learning
They/them, she/her, he/him, ze/hir, etc.
For casual contact. For example, if we need to be in touch on the day about a program, pick-up, drop-off, etc.
They/them, she/her, he/him, ze/hir, etc.

Emergency Contact Information

They/them, she/her, he/him, ze/hir, etc.

Medical Information

Does your youth need any extra support? This can be medical, social, physical, emotional, etc. Please let us know how best to help your youth.

Consent

Consent for the below listed items are for the year of 2023. You can withdraw consent for individuals by emailing us.
Occasionally our facilitators want to take youth around Dartmouth. Some examples of previous activities include a mural walk, a photo walk, sketching in the park, etc.
Photography and video may be used on our website, social media channels, and promotional materials for the centre. Quotes/comments/thoughts made on evaluation forms, may be used on our website, social media channels, advertisements and promotional materials.

Leaving the Centre

How does your youth get home at the end of the day?
Specifically, if you selected that another person (s) may receive your youth at end of day, please use this field to indicate such person (s).