Parent Permission Form  - Outdoors Club Canoe Trip in Killarney Provincial Park
Please read this information package carefully.  It pertains to your son’s trip to Killarney Provincial Park with the UCC Outdoors Club.  The purpose of this form is to seek your permission for your son to participate in this activity.  If your son has, or has had, any previous or current health problems, which the Supervisor-in-Charge should know about, please give full particulars in writing.  Please complete this permission form  before Monday, Sept.16.  

Nature and Purpose of the Program:  Students will travel to destination for the purpose of developing leadership and outdoor skills, and to help foster an appreciation for the outdoors and healthy living.

Requirements: A detailed clothing/equipment list is shared; students will need to bring $40 for food on the way up and back.

Date:  Friday, Sept.20 - Monday, Sept.23, 2019

Destination: Killarney Provincial Park

Method of Transportation: School Bus

Departure time/place: 8:30am from UCC north parking lot

Return time/place: 4pm at UCC north parking lot

Financial Cost:  $300-425 (depends on the # of students who sign up)

Teacher/Staff: Zach Williams and Dave Borden

RISK MANAGEMENT CHART. PLEASE READ IT CAREFULLY.

Travel: Bus Travel has inherent risks – we will be using a school bus with a professional driver. Hiking & portaging could lead to sprains or breaks. Canoeing could lead to dumps and exposure to cold water. We will paddle close to shore and close to each other and hike/portage in groups.

Health and Safety: Mr. Williams & Mr. Borden have valid certification in Wilderness First Responder (First Aid). We will bring a first aid kit to all destinations during the trip. Teacher will carry student emergency contact and medical information with him at all times. Students will be accompanied by teachers at all times. We will bring a SPOT satellite signaling device and have created an emergency evacuation plan should an emergency situation arise.

Environmental: Weather could be cold and wet. An extensive clothing and gear list will be given to students, and a gear check will be done the day before departure. Teachers will monitor students for signs of cold related illness. Teachers will encourage students to eat and drink enough.

Political: None.

Other: Please feel free to attend risk assessment and mitigation meeting scheduled for 5pm on Monday, Sept.16, 2019 in room 213 at UCC.


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Student Number
Your son's name *
Your name *
Your cell number during the day in case of emergency. *
Does your son have any food restrictions religious or otherwise? If so please list below. *
The undersigned hereby releases Upper Canada College, its respective directors, officers and employees of and from any and all claims whatsoever arising or which may arise by reason of the Child’s participation in any aspect of this Canoe trip to the Killarney Provincial Park, including any claims due to personal injuries, death or illness.Should the Child suffer injury or illness while participating in any aspect of this trip the undersigned hereby authorizes any representative of Upper Canada College and, in particular, any staff member accompanying the Child to authorize such medical attention for the Child as may be deemed appropriate by said representative of UCC in the circumstances.  The undersigned agrees to bear the costs of all medical care and procedures required by the Child.  The undersigned also agrees to maintain appropriate medical insurance coverage for the Child while on this trip. The undersigned hereby releases UCC, its respective directors, officers and employees from any claim arising out of any medical treatment the Child may require.The undersigned acknowledges that should the Child fail to keep and obey all rules and regulations prescribed by UCC, its respective directors, officers and employees, while participating on this trip UCC may, in its sole and absolute discretion, terminate the Child’s participation in this trip without refund for the costs.  Any additional costs incurred by reason of the termination of the Child’s participation in the trip and/or as a result of the Child being sent home will be the responsibility of the undersigned. *
I acknowledge all risks involved and by typing my name here I am allowing my son to participate in this field trip. (first and last name of parent). *
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