PARENTAL CONSENT FORM – EduRepublic

SECTION A: CHILD'S INFORMATION

Full Name of Child:

Date of Birth:

Age

Class / Programme Enrolled In:

SECTION B: PARENT / GUARDIAN INFORMATION

Full Name of Parent/Guardian:

Relationship to Child:

Phone Number:

Email Adress:

Home Address:

Address Line 1

City

SECTION C: PURPOSE OF THIS FORM

EduRepublic is an edtech facility that operates a learning centre, content studio, workspace, and café. In the course of our programmes and events, we may photograph or film children for educational,

promotional, or documentary purposes.

In line with our Child Safety & Privacy Policy, the following standards apply to all events involving

minors at EduRepublic:

The Hub (workspace, studio, café, and common areas) will be closed to the general public for theduration of the event.
Only EduRepublic staff and pre-approved persons will be permitted on the premises.
Customers and the general public will be notified in advance across our communication platforms.
No child will be photographed or filmed without a signed parental consent form on file.

SECTION D: PHOTOGRAPHY & FILMING CONSENT

Please indicate your consent by ticking the appropriate boxes:

I CONSENT to my child being:

Photographed during EduRepublic programmes and events

Filmed/videoed during EduRepublic programmes and events

Featured in EduRepublic's social media content (Instagram, Facebook, X, etc.)

Featured in EduRepublic's website and digital marketing materials

Featured in printed materials (flyers, banners, brochures)

Featured in documentary or educational video content produced at the studio

I DO NOT CONSENT to my child being:

Photographed or filmed in any capacity

Featured on social media

Featured in marketing or promotional materials

Identified by full name in any published content

Please note: If no boxes are ticked, it will be assumed that consent is NOT granted, and the

child will not be photographed or filmed.

SECTION E: EVENT PARTICIPATION CONSENT

I CONSENT to my child being:

I consent to my child participating in EduRepublic events, workshops, and programmes, including those held within the content studio, learning spaces, and associated areas of the facility.

I understand that during such events, the Hub will be restricted to staff and approved persons only, and that EduRepublic will take reasonable measures to ensure my child's safety and supervision throughout.

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Some description about this section

SECTION F: MEDICAL & EMERGENCY INFORMATION

Known Allergies or Medical Conditions:

Emergency Contact (if different from above):

Name

Phone

Relationship to Child

SECTION G: DECLARATION

By signing below, I confirm that:

1. I am the parent or legal guardian of the child named in Section A.

2. I have read and understood the terms of this consent form.

3. The information I have provided is accurate and complete.

4. I understand that I may withdraw my consent at any time by contacting EduRepublic in writing

at admin@edurepublic.org .

5. I understand that EduRepublic will handle all personal data in accordance with applicable data

protection and privacy laws.

Parent/Guardian Signature

Choose File

Printed Name:

Date:

EduRepublic | 8-10 Idi-Iroko Close, Langbasa, Addo, Ajah | 08137035273 | admin@edurepublic.org

This form is to be retained securely by EduRepublic and is strictly confidential.