405 Munroe Avenue,
Winnipeg, Manitoba
R2K 1H5
Tele: 661-4451 Fax: 667-6211
Principal/Directeur
Ms. W. Walder
Vice Principal/Directeur-adjoint
Ms. C. Nick-Johnson
April 2014
PARENTAL INFORMED CONSENT FOR OUT-OF-SCHOOL ACTIVITIES
Dear Parent(s)/Guardian(s):
Part of the Wilderness Education course is dedicated towards sustainable wilderness / outdoor activities. We have scheduled a three-day trip to Spruce Woods Provincial Park, for Wednesday, to complete the Epinette Creek Trail Hike. During this trip students will be participating in hiking, fire starting, camp set-up and food preparation. Along with these hands on outdoor activities, this trip also allows the students to work through the process of planning an extended outing which includes topics such as: route planning, food selection, hydration, appropriate clothing and equipment, and backpacks.
This trip has been chosen based on its accessibility, level of difficulty, and interest.
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Trip date : May 14-16, 2014
To ensure that you are well informed about this trip, we invite parents or guardians to attend a short (30 minute) and very important meeting on April 24 th , 2014 at 5:30-6:00 in the
Munroe library. At this meeting, we will collect the consent forms and medical forms. Full or partial payment of the $50.00 would also be appreciated and helpful to our pre-trip preparations.
Cost includes transportation and food for the 3 days (other than bagged lunch first day).
If you have any questions please feel free to call the school and speak to Mr. Coppinger at 661-
4451.
Sincerely,
Mr.Coppinger and Mr.Bezte
Outdoor Wilderness Education Teachers

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Table of Contents
Introduction
Hiking Trip 2014 - “Epinette Creek Trail”
A.
B.
Spruce Woods Provincial Park Directions
Transportation
Route Description
Our Leaders
Student Requirements
Parent Requirements
Safety Precautions
Emergency Telephone Numbers
I.
Itinerary
Attachments:
Supply List
Consent Form
Medical Form
Trip Preparation Schedule

Introduction to Hiking Trip 2014 - “Epinette Creek Trail”
With an area of 269 km 2 , Spruce Woods Provincial Park is characterized by spruce parkland, upland deciduous forest, mixed grass prairie, open and stabilized sand dunes, and river bottom forest. Classified as a Natural Park, its purpose is to preserve areas that are representative of the Assiniboine Delta Natural Region: and accommodate a diversity of recreational opportunities and resources.
A.
Spruce Woods Provincial Park - Directions
From Winnipeg travel west on Highway #1 to Highway #5. Travel south on
Highway #5 through the town of Carberry to Spruce Woods Provincial Park. The
Epinette Creek Trail system is located on the north side of the park approximately
20 minutes from Carberry.
B.
Transportation
We will be traveling to the hiking route staging area by school bus. One teacher will be travelling by truck to have a vehicle at our disposal.
C.
Route Description
Epinette Creek Hiking Trail System
Off PTH 5, 10 km north of Assiniboine River. We will begin our hike in the parking lot at the first cabin. Our first day takes us along the Spruce Trail past the second cabin. We will then continue on the Juniper, Tamarack (past the third cabin) and Newfoundland Trails (total of approx. 19.5kms) before setting up camp at the fourth cabin for our first evening. Our second day we hike the
Newfoundland and Tamarack Trails back to the second cabin where we set up camp for our second night. Our last day leaves us with a short hike out to the parking lot before returning home.
The entire route is a well-marked groomed trail that the park personnel maintain thoroughly. Each cabin/camp is accessible by vehicle as well as much of the trail.
Each cabin/camp offers shelter, water and toilet facilities.

D.
Our Leaders
Mr. Bezte: o Grade 9 Classroom teacher (including Wilderness Ed) o Avid outdoorsman with extensive backcountry camping experience. o Trained in 40 hour Wilderness First Aid
Mr. Coppinger: o Grade 9 Classroom teacher (including Wilderness Ed) o Avid outdoorsman with extensive backcountry experience.
Mme. Lepine o Grade 7 Classroom Teacher o Avid outdoorswoman with extensive backcountry experience.
E.
Student Requirements
 Physical Health and Fitness: o medical information sheet must be filled out and returned to school o refer to attached checklists for physical requirements
 Students will conduct themselves in an appropriate, respectful and safe manner. Failure to do so will result in removal from the trip at the student’s/parent’s expense.
 Students are invited to attend an orientation evening scheduled for April
24 th , 2014.
 Permission slip must be returned to school
F.
Parent Requirements
 Complete all the necessary consent forms.
 Arrange for payment $50.00 payable to Munroe Junior High.
 Make arrangements to acquire supplies needed by student.
 Arrange for return transportation (at own expense) of son/daughter in the event that the behavior of their son/daughter jeopardizes the safety of others and needs to be removed from trip.
 Parent is invited to attend an orientation evening scheduled for April 24 th
2014 in the Munroe library.

G.
Safety Precautions
 All campsites have a cabin that may be used in the event of extreme weather.
 All campsites are accessible by vehicle in the event of an emergency.
 Safety assessment of route has been completed by Mr. Coppinger.
 Trip leaders will be carrying a SPOT (GPS enabled one-way
communication device) and make daily contact with the school.
 Copies of the route, names and medical numbers will be carried on the trip and also left with the school principal
 Group will register and leave trip plan with the Spruce Woods Provincial
Park (Manitoba Conservation)
 First aid kit will be carried on the trip
 Trip may be done part way and return the same way should we be held up by poor weather or other obstructions. (see route description and maps)
 Backpackers will travel close together, within whistle contact, with a supervisor in the lead and a supervisor at the rear of the group.
 In the event of a major illness or injury, qualified first aid leaders will be on the trip and phone contact can be made to have the ill party transported out (if necessary)
 The staff to student ratio will not exceed 1:10
 There is no cell phone service and no way to charge them. We recommend that phones be left at home. All phones on the trip will be collected for night.
H.
Emergency Telephone Numbers
Carberry District Office
RCMP - Carberry
RCMP - Treherne
Carberry Hospital
Glenboro Hospital
Emergency
834-8800
834-2131
723-2345
834-2144
827-2438
911

I.
Itinerary
Date Time (approx.) Activity
Day 1
Day 2
8:00 a.m.
9:30
12noon
12:30 p.m.
5:30
6:30
7:00
9:00 p.m.
8:00 a.m.
9:00
Arrive at Munroe.
Depart for Spruce Woods
Arrive at Spruce Woods, bag lunch
Depart for cabin #4
Arrive at cabin #4, make camp
Supper
Evening Activity
Snack & Campfire
Day 3
1:00 p.m.
2:30
5:30
7:00
9:00 p.m.
8:00 a.m.
Breakfast
Break camp, head back to cabin
#2
Arrive at cabin #2, make camp, lunch
Afternoon Activity
Supper
Evening Activity
Snack & Campfire
Breakfast, break camp
10:30
11:00
Arrive at parking lot, lunch
Load bus to return home
1:30 p.m. Arrive at Munroe.
Munroe Hiking Trip Supply List
The school will provide the following items.
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Backpack
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Sleeping pad
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Whistle
Cooking Utensils
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Tent
Stoves (fuel)
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Pots
Water purification system
Compasses
Food

The following items need to be provided by the student.
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Plate (plastic)
Cup (plastic)
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Toothbrush
Comb/brush
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Sunglasses
4-5 large ziplock bags
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Bowl (plastic)
Knife, fork, spoon camera
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Toothpaste
Biodegradable soap
Flashlight (new
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4-5 large garbage bags sunscreen (can be shared) insect repellant (can
 be shared) bagged lunch for day 1
(optional – but will be collected for noght)
Clothing
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 batteries!!) sleeping bag toilet paper
(1 roll in Ziploc) rainwear (jacket with sleeves & rain pants if possible)
1 pair long pants (non-cotton if
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3 pair socks sweater/sweatshirt
1 pair solid footwear (may want
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 possible) long sleeved shirt
2 t-shirts hat shorts undergarments
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 to bring a light pair of sandals to wear around camp if shoes need drying) jacket (can use your raincoat if suitable) long underwear toque mitts
Important!!! - Weight is always a factor and space will be limited. Please be aware of the weight and bulk of your gear.
Munroe Spring Hiking Trip 2014
Date Time
Thursday April 24 5:30-6:00 pm
*Tuesday April 15 11:33am-12:25pm
Topic Supplies Needed
Parent Orientation Parents & Hiker
Packing list Bagged Lunch

*Thurs April 24 11:33am-12:25pm Meal Planning
*Thursday May 1
*Wed May 7
11:33am-12:25pm
11:33am-12:25pm
Tent set-up
Packing
Tuesday May 13 11:33am-12:25pm Last minute checkin
Bagged Lunch
Ideas/Allergy Info
Bagged Lunch
All Clothes & Packs
Bagged Lunch extras - forgotten items
Wednesday,May 14 Meet at School at
8:30 am
Friday, May 16 Arrive at School at
2:00 pm
Tuesday, May 20th
Depart for Spruce
Woods
Quick Clean Up
Return Cleaned equipment
*All starred dates are for Wilderness Ed Club only. All students in the Wilderness course will cover all of the above topics in class.
Clothes (see detailed list - bring in on Wednesday, May 7 th )
Warm sleeping bag (bring in on Wednesday, May 7 th )
Quality Rain Gear
Things to look for in a good sleeping bag:
1) Temperature rating. It can get as cold as –5 overnight.
2) Size- The smaller the better!
3) Stuff Sacks- It is important to have a stuff sack to keep your sleeping bag in.
Superstore sells a waterproof Tera Gear one for quite cheap.
(mummy style bags are great - *if you have to purchase a sleeping bag check out
Superstore, they sell a mummy style bag for about $40-$50 - the quality is satisfactory and it does the job)
5 large black garbage bags
5 Medium ziploc bags
10 large ziploc bags

Informed Consent:
Activity Title: SpruceWoods Epinette Creek Hiking Trip
Dates of activity:
May 14 th , 15 th and 16th
Name of Student (please print):_________________________________ TA/TU: _________
I / We, the undersigned, hereby acknowledge that certain risks of injury are inherent in the participation in sports, recreational activities and other off-school site programs. These types of injuries may be minor or serious.
I / We understand that, in case of emergency medical or hospital services being required by the abovelisted participant, and with the understanding that every reasonable effort will be made by the school/hospital to contact me, my signature on this form authorizes the board, through its employees, agents, and officers, [to] secure such medical advice and services as they deem necessary for my child’s health and safety, and that I shall be financially responsible for such advice and services.
I / We understand that the Rules and Regulations pertaining to this activity are designed for the safety and protection of participants
I / We acknowledge my right to obtain as much information as I require about this program or activity and associated risks and hazards, including information beyond that provided to me by the school.
I / We acknowledge that it is my responsibility to advise the school of any medical and/or health concerns of my child that may affect his/her participation in the stated program or activity.
I / We understand that the choice to participate brings with the individual the ASSUMPTION OF RISK which is part of those activities.
I / We understand and agree that this is a part of the school program. I/We also understand that as a result of participating in this program that the participant is expected to follow the school procedures and code of conduct and that any deviations from these may result in consequences from the school administration.
I / We declare having read and understood the above INFORMED CONSENT AGREEMENT in its entirety and hereby consent to participate being aware of all the foregoing.
___________________________________ ________________________
Parent/Guardian Signature Date
In order for your child to participate in this event, this signed consent form must be received at the school before the event.

Student Name: ________________________________________________________ Birth Date: ________________________
Manitoba Health Registration No. (6-digits): __________________ Manitoba PHIN (9-digits): ____________________________
Extended Health Insurance:

Yes

No Extended Health Contract Number: ____________________________
Allergies (e.g., specific drugs, certain foods, insect stings, hay fever) Specify:
______________________________________________________________________________________________________
Reaction(s) to above? ____________________________________________________________________________________
Carries Epi pen?  Yes  No
Date of last known Tetanus Shot:
Medical/physical conditions that may affect participation in the stated program/activity (e.g., recent illness or injury, chronic conditions, phobias, etc.). Be specific:
______________________________________________________________________________________________________
Specify the condition(s) and requirements for program modification or specific activities your child should not participate in:
______________________________________________________________________________________________________
Medication(s) taken (name, reason, dosage, storage, potential side effects/treatment of such):
_________________________________________________________________________________________________________
Other Health/Medical/Dietary Concerns:
_________________________________________________________________________________________________________
Emergency Contacts:
1) ____________________________________ Phone: (H) ____________________ (W) ___________________ (C) __________
2) ____________________________________ Phone: (H) ____________________ (W) ___________________ (C) __________