Remembrance Day Walk to Remember

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ATTENTION: This is a legal document. Please read carefully the contents of this consent form and clarify any concerns with the staff at the school organizing the event or the School Principal before completing each section.

It is important that this form is completed in its entirety, and electronically signed, in order for your child to participate in this activity.

PRIVACY NOTICE:
Waverley Memorial Elementary School is collecting the personal information requested in this form to: obtain lawful consent for your child to participate in the activity; coordinate the activity; respond and report respecting any injury or medical condition that may arise during, or as a result of the activity; and update School records where necessary.

The information will only be accessed by authorized School staff and will be dealt with in accordance with the privacy requirements of the Nova Scotia Freedom of Information and Protection of Privacy Act.

The information will not be disclosed to any other person or agency unless it is for a purpose stated above, the disclosure is authorized or required by law, or you have given the School permission for the information to be disclosed.

IN CONSIDERATION of Waverley Memorial Elementary School offering my child, an opportunity to participate in the activity described below on November 10th, I hereby give and provide my consent, and acknowledge by my signature that my child may participate.

We will be walking to the Waverley Legion on November 10th between 10 and 10:30 am to lay wreaths and observe a moment of silence. Students will be supervised by staff members of WMES.

Please complete this form by Friday, November 4th.

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ACTIVITY RISKS:
There are inherent risks, hazards and dangers while participating in walking trips. Some risks include: effects of weather; existing and changing walking route; collision with natural and man-made objects and with others; condition of the terrain, environment and facilities; unmarked obstacles; ability and fitness of students; separation from the group; insect bites, poison plants and wildlife; acts of fellow participants; injury, paralysis or death

I am aware of the usual risks and danger involved in participation in this activity, including any specified above and of the possibility of personal injury, fatal injury, property damage or loss that may result.

I understand and consent

I do not consent

SUPERVISION:

I understand that my child will be supervised by their classroom teacher, as well as other WMES staff members.

I understand

HEALTH AND MEDICAL TREATMENT:

1. My child does not have any illness, allergy, or disability that prevents his or her participation in this event

2. My child has an illness, allergy, or disability that could affect his or her participation in this event.

If you checked #2 above please list illness, allergy, or disability:

EQUIPMENT AND CLOTHING:

Students will need to be dressed accordingly for the weather on the 10th (sneakers/boots that are comfortable for walking, and appropriate outer wear for the weather).

I acknowledge that it is the responsibility of me and my child to ensure that all necessary clothing is brought by my child to the event and acknowledge that my child may be prevented from participation if s/he does not have all necessary clothing.

I understand and will ensure my child is dressed appropriately

CODE OF CONDUCT & ACTIVITY SITE RULES AND REGULATIONS:

My child and I understand that the Regional Code of Conduct applies during this activity. My child and I also understand that site rules and regulations are in place for this activity and my child agrees to abide by these rules and regulations. I acknowledge that I have explained to my child that any prohibited actions may result in my child not being allowed to participate or continue in the activity.

I understand

RISK OF ACCIDENT:

Accidents can result from the nature of this activity and can occur with or without any fault on either the part of the student, HRCE or its employees or agents, or the facility where the activity is taking place. By allowing my child to participate in this activity, I accept the risk of an accident and agree that this activity, as described above, is suitable for my child.

I agree and consent

NON-PARTICIPATION IN THIS EVENT:

I understand that if I am not comfortable with my child participating in this activity that arrangements will be made for my child to remain at the School during School hours and my child will not be penalized for non-participation.

I understand

CONTACT INFORMATION:

Should the School need to contact me during this event:

Contact Number Valid for the Time of the Activity:

Alternate contact information if necessary: *

CONSENT

In signing this Consent, I am not relying on any oral or written representation or statement(s) made by the Regional Centre, its servants, agents, employees, or authorized volunteers to induce me to allow my child’s participation in this activity other than those contained in this Consent.

I acknowledge the Privacy Notice, above.

I am 19 years of age or older and I have carefully read the contents of this Consent Form and have clarified any concerns with the staff at the School organizing the event or the School Principal before signing each page. I understand that it is a legal document that is binding on me, my heirs, executors and administrators.

Student's First Name: *

Student's Last Name: *

Class: *

Pre-Primary Ms. Sidney

Pre-Primary Ms. Jessie

Primary Brien / Coyle

Primary / One MacLellan

One Wadden / Miller

Two Day

Two Johnson

Two / Three Macdonald / Smith

Three / Four Hillier

Three / Four Bailey

Four / Five Rigby

Five van der Weegan / Smith

Five Smith

Citas:

Jāaizpilda obligāti

Name / Signature of Legal Guardian: *

Date: *

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