Meadowridge School
Parent/Guardian Consent Form
and
Acknowledgement of Risk
Name of Field
Trip:
Gr.4/5 GIRLS VOLLEYBALL
Megan Gager
Selena Dobie
megan.gager@meadowridge.bc.ca
selena.dobie@meadowridge.bc.ca
Student Name:
school: 604-467-4444 ext.121
school: 604-467-4444 ext.138
Student
Homeroom:
Date(s) of Trip:
Home Games, no driver’s needed:
Oct.1/Thur
Gr.4/5 Girls volleyball HOST Southridge (2 teams)
& Urban Academy (1 team) 3:45-4:45pm
Oct.26/Mon
Gr.4/5 Girls volleyball HOST West Point Grey Academy 3:45-5:00pm
Please check the games you can assist and complete the box below.
Away Games Requesting Drivers:
□ Oct.19/Mon
Gr.4/5 Girls volleyball AWAY at Mulgrave with West Point Grey Academy
parent driver’s requested 2330 Cypress Lane, West Vancouver
Games from 3:30pm – 5:00pm
Request dismissal from class at 2:00pm and depart 2:10pm sharp.
□ Nov.3/Tue
Gr.5 Girls ISEA Volleyball Championship at the Richmond Olympic Oval
All day event and the times are TBA parent driver’s requested
PARENT DRIVERS / VOLUNTEERS (check if completed)
 YES, I have provided the office with a current driver’s abstract
Call 1 800 950-1498 and have your driver’s license in front of you. You will be asked a few
questions. Have them fax the result directly to the school at 604 467-4989 where it will be kept on file.
FREE and usually only takes about 2-3 minutes.
 I have a minimum of $2 million third party liability coverage.
 I have seatbelts to transport the following number of passengers ______
 I am available to provide transportation to the indicated AWAY GAMES.
UNIFORM WHITE SOCKS – INVOICED $10 (ONLY IF THE BOX BELOW IS CHECKED)
To try and keep the teams looking uniform we ask that all soccer and volleyball players wear white socks. The
school will provide socks to the students with your consent and you will be invoiced $10 through the accounting
department. Do not send money, it is not required.

Do you consent to being invoiced $10 if your son or daughter requests & receives socks?
EDUCATIONAL VALUE (to be copied from the approved Risk Assessment form)
Educational Goals:
Developing fitness and skills levels
Student Preparation:
Practices and training at school with coaches on a regular basis.
SAFETY PLAN
Site Terrain
School gymnasiums and travelling in between.
Weather
Rain or shine – games played inside.
Equipment/Clothing
PE strip and team jerseys, shorts and knee pads recommended.
Water/Food
Each child to bring snacks and water if necessary, but relatively short trip and playing
time.
Typical gym environment and travel requirements in between.
Hazards: Sun, insects,
animals
Emergency Response
Contingency Plan
Call 911 if needed. All games are local so a fairly good general knowledge by many
around if a clinic or hospital is required.
I understand that my child/charge may be transported by parent driver(s) or school bus/van to off-site games, and
therefore is exposed to risks normally associated with the use of these modes of transportation.
I also understand that due to the nature of the team sport in which my child/charge will be participating, there are risks
inherent in such activities that may result in possible injuries.
Efforts taken to minimize the risk of injuries include the following:

Developing the fitness and skill level of the participants.

Supervising the students to help participants play by the rules for safety and fun.

Keeping safety in mind every time participants play.

Treating injuries that may occur during practices and games and ensuring that injured players do not play through
an injury.
I have discussed the risks and expectations of this trip with my child/charge, and have confidence that my child/charge
has understood them. I am satisfied with the field trip planning information and I am now content to allow my
child/charge to proceed on the trip as they wish.
I have read this agreement at my leisure, understood the nature of its intent and its contents. Please permit my
child/charge the opportunity to participate in this field trip and all of its activities.
As parent/guardian, I will ensure that my child/charge is prepared and has the necessary items for the trip listed
on the attached sheet.
Parent/Guardian PRINT NAME: ______________________________________________
Parent/Guardian SIGNATURE: ______________________________________________Date: ______________
PLEASE RETURN THIS FORM TO the coach, in order for your child/charge to be involved in this activity.
Parents and fans are strongly encouraged to attend games.
KEEP THIS COPY FOR YOUR OWN RECORDS
ISEA Gr.4/5 GIRLS VOLLEYBALL SCHEDULE 2015
Megan Gager
Selena Dobie
megan.gager@meadowridge.bc.ca
selena.dobie@meadowridge.bc.ca
school: 604-467-4444 ext.121
school: 604-467-4444 ext.138
Oct.1/Thur
Gr.4/5 Girls volleyball HOST Southridge (2 teams)
& Urban Academy (1 team) 3:45-4:45pm
Oct.19/Mon
Gr.4/5 Girls volleyball AWAY at Mulgrave with West Point Grey Academy
parent driver’s requested 2330 Cypress Lane, West Vancouver
Games from 3:30pm – 5:00pm
Request dismissal from class at 2:00pm and depart 2:10pm sharp.
Oct.26/Mon
Gr.4/5 Girls volleyball HOST West Point Grey Academy 3:45-5:00pm
Nov.3/Tue
Gr.5 Girls ISEA Volleyball Championship at the Richmond Olympic Oval
All day event and the times are TBA parent driver’s requested