Consent to Participate and Photo Release - Hatchlings, In the Nest

Mother Goose on the Loose, Hatchlings: In the Nest

Pilot Program

You are being invited to participate in the pilot of a new program: Mother Goose on the Loose,  Hatchlings: In the Nest! The Hatchlings: In the Nest program is for families with newborns. It is based on the award-winning early literacy Mother Goose on the Loose program for children from birth to age 3 with their parents or caregivers https://mgol.net/.

The purpose of the Hatchlings program is to increase awareness in early literacy skills, the  importance of reading, and child development milestones. These programs will be fun and interactive to model bonding around early literacy activities. Families  will be given materials, in the form of books and educational toys, to keep and use at home. Parents will be asked to complete  program evaluation surveys and may receive a follow-up phone call. 
1.Privacy and Confidentiality

All survey responses and data collected will be kept confidential. Participants will not be identified by name in any publication or presentation, unless they want their name published and grant permission.
2.Permission to Use Photograph / Video

Photographs / videos of participants will be taken during the Mother Goose on the Loose Hatchlings program. With your permission, these photos and video clips may be shared with project partners, at conferences, on websites, and for publications, such as, Maryland State Library, American Library Association, Mother Goose on the Loose website, and Children & Libraries magazine and may be used for any lawful purpose including publicity, illustration, advertising, and Web content.
3.I have read and understand all of the above.
4.Name
5.Address
6.Email (If you do not use email, please write, none, in the space below.)
7.Phone
8.Date
9.County
Current Progress,
0 of 9 answered