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OCDSB 907 Extra Curricular Sport and Travel Consent Form (2)OCDSB 907: Extra-Curricular Sport and Travel Consent Form CONSENT FOR EXTRA-CURRICULAR SPORT Your child has expressed interest in joining It runs from to and the expected practice schedule, including league games, tournaments and other related activities, is described below: Team authorities are expected to exercise reasonable precautions to avoid injury. The Ontario Physical Education Safety Guidelines designate: CONSENT FOR ATHLETIC DAY TRIP TRAVEL Travel for team related events, or athletic day trips, may occur throughout the season. Travel dates, locations, and method of transportation, which may include volunteer drivers, are described below. Parents will be notified about any changes to this schedule as soon as they are made available by the appropriate coach and/or supervisor. Date: Signature of Principal: OCDSB 907 (November 2017)Page 1 as a HIGHER/ LOWER risk activity. (Please select one) Lead Coach/Supervisor: Names of Coaches/Supervisors: . PLEASE RETURN BY: STUDENT/ATHLETE HEALTH INFORMATION SHEET Please complete the following health form so that the coaching staff is aware of any medical issues that might affect your child’s play. Player’s Name: Date of Birth: Home Telephone No.: Provincial Health Number (optional): Parent/Guardian Name: Parent/Guardian Phone No.: Parent/Guardian Name: Parent/Guardian Phone No.: Emergency Contact Name (if parents are not available): Telephone No.: Please check the appropriate response pertaining to your child and provide additional details below. Yes No Previous history of concussions (Please provide details) Yes No Hearing problem Yes No Fainting episodes during exercise Yes No Heart Condition Yes No Asthma Yes No Diabetic Yes No Trouble breathing during exercise Yes No Has had an illness lasting more than a week in the past year Yes No Epileptic Yes No Medication (please provide details) Yes No Wears glasses Yes No Allergies (please provide details) Yes No Are lenses shatterproof? Yes No Wears a medic alert bracelet or necklace (please provide details) Yes No Wears contact lenses Yes No Injuries/illnesses requiring medical attention in the past year (please provide details) Yes No Wears dental appliance (details) Yes No Presently injured (please provide details) Yes No Does your child have any other health problems that would interfere with his/her participation in athletic activities? Day/Month/Year OCDSB 907 (November 2017)Page 2 Please give details below if you answered “Yes” to any of the above items. Medications: Allergies: Medical Conditions: Recent Injuries: Any information not covered above: Should your son/daughter sustain an injury, concussion or contract an illness requiring medical attention during the competitive season, please notify the coach/teacher/supervisor. Parent and Student Consent I understand that it is my responsibility to keep the team management advised of any change in the above information as soon as possible and that in the event that no one can be contacted, team management will take my child to the hospital if deemed necessary. I hereby authorize the physician and nursing staff to undertake the examination, investigation and necessary treatment of my child. I also authorize release of information to appropriate people (physicians) as deemed necessary. I understand that participation on a school team is a privilege and, as such, students are expected to obey school rules, follow the National Capital Secondary School Athletic Association (NCSSAA) or Ottawa-Carleton Elementary Athletic Association (OCEAA) Code of Conduct for Athletes, and fulfill their commitment to their team until the season is over. Failure to do so may result in suspension from school athletics for the following season. I have received and read the background information supplied with this request. Permission is given to the Ottawa-Carleton District School Board for the following student to participate in the activity described above. If the activity supervisor deems the student’s behavior so disruptive and/or inappropriate as to warrant cancellation of his/her activity privileges, I agree that he/she will be returned home at my/our (i.e., parents’/guardians’) expense. I give consent for my child to participate in the designated sporting activity. Date: Signature of Parent/Guardian: I give consent for my child to travel as part of the designated sporting activity. Date: Signature of Parent/Guardian: OCDSB 907 (November 2017)Page 3