SKATING – Permission Form and Liability Waiver
Collettville Elementary School
(Phone 250-378-2230)
Section 1 – Field Trip Itinerary – SKATING
Destination: Skating – Memorial Arena
Date: Monday, January 18, 2016 for
Div 7 (Remy) & Div 5 (Crepet) – 9:15 – 10:40
Date: Wednesday, January 20, 2016 for
Div 3 (Cote) & Div 4 (Cugino) – 10:15 – 11:40
Date: Thursday, January 21, 2016 for
Div. 1 (Anscomb), Div 2 (Cloet) & Div 6 (Sember) – 9:15 – 10:40
Overview itinerary for the Field Trip Program: Carnaval Activity – Skating at Nicola Valley Memorial Arena for all classes. Students will be transported to and from
the arena by school bus. We also need a minimum of 3 parent supervisors per group to help with supervision and tie skates.
PLEASE NOTE: HELMET WEAR IS MANDATORY, you must provide your own. (School has extra skates but no helmets).
Staff in Charge and level of Supervision Provided: Classroom teachers and parent helpers.
Leave School at:
9:15 a.m. or 10:15
Time on Site: 1 hour
Back at school: 10:40 a.m. or 11:40
-------------------PLEASE TEAR OFF AND RETURN SECTIONS 2, 3 & 4 TO THE SCHOOL ------------------Section 2 – Student Data
SKATING – CARNAVAL 2016
Student Name: ______________________________________________
Destination: Nicola Valley Memorial Arena
Date: Monday, January 18, 2016 for
Div 7 (Remy) & Div 5 (Crepet) – 9:15
Date: Wednesday, January 20, 2016 for
Div 3 (Cote) & Div 4 (Cugino) – 10:15
Date: Thursday, January 21, 2016 for
Div. 1 (Anscomb), Div 2(Cloet) & Div 6 (Sember) – 9:15
Transportation: School Bus
If different from the information we have on file, please fill out the section below.
Home Phone: ____________________
Care Card # _________________________
Parent/Guardian: _________________________________________
Work Phone: _________________________
Emergency Contact: ______________________________________
Emergency Phone: (H) ___________________
(W) _____________________
Section 3 – Parent/Guardian Consent
I understand that such a program has many positive attributes, yet there is always the possibility of injury or harm. The staff in charge will do their best to ensure the
safety and well-being of the entire group.
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I will not hold School District # 58 (Nicola-Similkameen) or any of its employees, including the above mentioned staff liable for any injuries to my child
that may occur during the Field Trip Program.
As this is a school outing, all regular school rules and policies apply. I am aware of the behavioral expectations for school field trips and the consequences if
behavioral problems arise.
I have read and agree with the information on this waiver form. I give my permission for my child to participate in this field trip.
I have carefully read the overview itinerary for the field trip program and I am aware of the risks inherent in participation in the described activity and I am
aware of the behavioral expectations.
_____________________________________________
______________________________
Parent/Guardian Signature
Date
_____________________________________________
Parent/Guardian Name (Please print)
Section 4 – Parent Volunteer – We need a minimum of 3 parents to help with supervision once we are at the arena and to help
with tying of skates etc., please fill in the information below.
Name: (Please print)_________________________________________
PH: _________________________
___ Yes, I will meet students @ Merritt Arena at 9:15 a.m. on Monday, Jan 18, 2016
___ Yes, I will meet students @ Merritt Arena at 10:15 a.m. on Wednesday, Jan 20, 2016
___ Yes, I will meet students @ Merritt Arena at 9:15 a.m. on Thursday, Jan 21, 2016
Div 7 & 5
Div 3 & 4
Div 1, 2, 6
School District No. 58(Nicola-Similkameen)
CELL: _________________________________