HomeMy WebLinkAboutOCDSB 905 Parental Consent for Overnight Trip Participation
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OCDSB 905 Parental Consent for Overnight Trip Participation Form
NOTE: A completed, signed copy of this form must be provided to the parent/guardian or student if over the
age of 18 years in advance of the overnight field trip or student exchange.
Overnight Trip Information
Name of School:
Description of Activities:
Supervisor(s):
Elements
of Risk:
Overnight Field Trips may present various elements of risk, as may various forms of related transportation including air flight. Accidents related to such activities may occur
and cause injury to a student or students through no fault of the school board, a transporter or of a facility at which activities take place. By choosing to have your child participate
in this activity, you are assuming the risk of an accident occurring. The chance of an accident occurring can be reduced when students carefully follow instructions at all times while
engaged in the activity. In addition to inherent transportation risks, unforeseeable political unrest and disasters may occur. The potential risks in this trip are:
a)
b)
c)
The
Ottawa-Carleton District School Board does not provide any accidental death, disability, dismemberment or medical expense insurance on behalf of students participating in this activity.
Location of medical and back-up facilities:
Departure Date:
Departure Time:
Via:
To:
Return Date:
Return Time:
Via:
Place:
In case of late return
or for other inquiries contact:
Cost of Tour/Exchange:
Signature of Principal:
To Parent or Guardian:
This is an important form and must be returned to the school regarding this field trip.
INSTRUCTIONS: Please complete and sign in the YES or NO section below
and return the form to the school.
YES
I give permission to the Ottawa-Carleton District School board for the following student to participate in
the field trip activity __________________________
_______________________________(description)
Scheduled to take place on or about ____________________________________________(date).
Name of Student:_______________________________________________
_________
Emergency Contact: _______________________________________Phone:______________________
Alternate Contact: _________________________________________Phone:______________________
Medical
Information:
Indicate any medical information or dietary restrictions that the supervising teacher needs to know.
Medical Consent: Should it become necessary for my child/ward to
receive medical care, I hereby authorize the teacher to use his/her best judgement in obtaining such care. I/we understand that any costs will be my/our responsibility. I also understand
that in the case of accident or illness I will be notified as soon as possible.
Elements of Risk: Any out of school activities may involve certain elements of risk. Injuries may occur
while participating in the activities related to this field trip. The chance of injury can occur without any fault of the student, the school board, its’ employees/agents or the facility
where the activity is taking place. I/we understand that any costs will be my/our responsibility as the OCDSB does not provide accident insurance coverage for student injuries that occur
during school activities.
I wish to volunteer for this trip: __________No Yes_____________
Phone: ______________________________
ACKNOWLEDGEMENT: I have received, read, and understand
all of the above, and give permission for my child/ward to participate in this activity.
Signature of Parent/Guardian: ____________________________Date: _______________________
NO
I
do not give permission for my child/ward ____________________________(name) to participate in the field trip activity
___________________________(description) scheduled to take place
on or about _______________________(date).
I understand that the trip is not compulsory and that any student not participating shall attend school.
Signature of Parent/Guardian: __________________
__________Date:________________________
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