HomeMy WebLinkAboutOCDSB 638 Parental Consent International Trip (2)
OCDSB 638 Parental Consent for International 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
international field trip or student exchange.
International Field Trip or Student Exchange Information
Name of School:
Description of Activities:
International Field Trip or Student Exchange Supervisor(s):
Elements of Risk:
International Field Trips or student exchanges 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.
OCDSB 638 (October 2017)Page 1
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:
Phone Number:
Cost of Tour/Exchange: $
Signature of Principal:
Page 2OCDSB 638 (October 2017)
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:
OCDSB 638 (October 2017)Page 3
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