Participation Consent & Disclaimer — [DAO Name]

Instructions for the DAO (delete before sharing): Fill in every [bracketed] field. Have this reviewed against your local law. Provide one copy to the school and one to each parent/guardian, and keep the signed copies securely.

About this activity

[DAO Name] is a community team taking part in Kambria’s DAO Experimentation Program (DEP) — an experimental, community-led initiative. This activity is organized and delivered by [DAO Name], not by Kambria. Kambria provides the overall program framework but does not deliver or supervise this activity on site.

What the activity involves: [plain-language description of the activity, where and when it takes place, and who from the DAO will be present].

Information we collect and how we use it

•     What we collect: [e.g., child’s first name, age group, and activity participation notes].
•     Why: to run and improve the activity and report on it in anonymized or aggregated form.
•     Images/quotes: we will only photograph, record, or quote a child, or share anything identifying them, if you tick the optional consent box below.
•     Storage & deletion: information is stored securely, accessible only to essential [DAO Name] team members, and deleted when no longer needed.
•     Your rights: you may ask to see, correct, or delete your child’s information, or withdraw consent at any time, by contacting [DAO safeguarding contact name + email].

Disclaimer

Participation is voluntary. [DAO Name] will take reasonable care during the activity. This activity is experimental and is delivered by [DAO Name]; Kambria is not responsible for its on-site delivery. By signing, you confirm you have read and understood the above.

Consent

I, [parent/guardian full name], am the parent/legal guardian of [child’s name], and I consent to my child taking part in this activity organized by [DAO Name].

[ ]  I also consent to my child being photographed/recorded and to those images/quotes being used for program highlights. (Optional)

Parent/Guardian signature: ______________________________   Date: ______________

School representative (if applicable): ______________________   Date: ______________

DAO safeguarding contact: [name] — [email]

Note: This template is a starting point, not legal advice. Confirm it meets the requirements of your local jurisdiction before use.