January 6, 2016
Dear Sir/Madam:
Please accept this letter as your invitation for the Grade 7 and 8 Indigenous students enrolled at your
school to attend our Annual Track and Field Event at Western University, on Wednesday, February 17
2016 from 9:30am to 2:00pm. This is an exciting event for the students to gain exposure to the
university environment, learn about physical fitness, school spirit, and teamwork.
Indigenous Services and the Western Mustangs’ Varsity Athletes team have collaborated to organize this
one-day event for grade 7 and 8 Indigenous students from elementary schools across Southwestern
Ontario. The day is filled with a variety of track and field activities (e.g. shot put, high jump, relay racing,
triple jump, long jump, etc.), lunch, speakers, and demonstrations from Varsity track and field athletes.
Every year, the students have a great time, meet incredible role models, and take home amazing
memories.
Agenda for the day:
9:00am arrival of students
9:30am start time for activities
10:00-12:00 rotation through stations led by varsity athletes
12:00-12:30pm Lunch
12:30-1:45pm rotation through stations led by varsity athletes
1:45-2:00pm Preparation for departure and buses
To ensure that your students do not miss this valuable educational opportunity, please register by
Wednesday February 10, 2016 via the registration form provided. This will allow us time to order your tshirts and prepare for lunch. The sooner you register the better! We also acknowledge that depending
on the travel time some groups may need arrive later or leave earlier, please let us know if this is the
case.
Please be advised that transportation to and from this event is not covered by Indigenous Services. If
transportation is a concern, you may consider contacting a school in your area and share the costs.
If you have any questions, please do not hesitate to contact me at any time.
Amanda Myers
B.A., B.Ed.
Youth Outreach Coordinator, Indigenous Services,Western University
Room 2100, Western Student Services Building
London, Ontario N6A 3K7
Fax:519-850-2578
amanda.myers@uwo.ca
519-661-2111 x86423
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11th Annual Indigenous Services Track & Field Day
Wednesday, February 17, 2016
REGISTRATION FORM
Print clearly please! T-shirts are Adult sizes: X-small to XXX-large.
School Name
Teachers/Chaperones
1.
2.
3.
Cellphone
T-Shirt Size
(Please photocopy this form and attach for more names, if needed)
Student Name (first, last)
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
T-shirt
Size
Student Name (first, last)
T-shirt
Size
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
Fax or email this completed form to confirm your attendance on or before Wednesday, February 10,
2014
Contact Amanda Myers @ Indigenous Services
Tel: 519-661-6111 x86423
Email: amand.myers@uwo.ca
Fax: 519-850-2578
Toll Free: 888-661-4095
Tel: 519-661-4095
Page 2 of 4
Assumption of Risk
My child, _____________________________________, wishes to participate in the 11 th Annual Track & Field Day program being
hosted by Western University and Indigenous Services on Wednesday February 17, 2016 at Thompson Arena. I understand and
agree to the following terms and conditions related to my child’s participation in this activity:
1) Participation in the activity may involve moderate to heavy exercise as well as the possibility of physical contact. It is my
responsibility to determine that my child is physically fit to participate in the activity and to advise Western of any and all of my
child’s medical conditions of which I am aware.
2) I understand that participation in the activity is voluntary.
3) I understand that my child’s participation in the activities of the event involve certain risks which include, but are not limited to, the
risk of physical injury. My child and I agree to assume these risks voluntarily.
4) My emergency contact information is provided below; and
5) While Western provides resources aimed at facilitating safe participation in the activities, it cannot ensure that participation will be
problem free or account for all potential health and safety risks. I have a shared responsibility to prepare my child in advance, to
research and be aware of the risks involved, to ensure that my child is physically and mentally prepared for participation and to
bring any concerns I may have to the attention of the appropriate representative as soon as possible.
6) I certify that I am the parent/guardian of the participant named above and that the named participant is completely healthy and
capable of participating in these activities.
7) In consideration of my child’s participation in the 11th Annual Track & Field Day program, I release the University of Western
Ontario, its directors, officers, employees, volunteers, agents and all organizations or individuals assisting in promoting, conducting
or otherwise affiliated with the 11th Annual Track & Field Day program from any and all causes of action or claims, including claims
for negligence (but not willful, fraudulent or malicious conduct) for any damages, expenses, losses or injuries arising from or relating
to my child’s participation. The participant named above (“my child”) enters into this activity voluntarily, and takes full
responsibility for the decision to participate or not to participate.
Parent/Guardian Name:
_______
Address:
Tel. Work:
Tel. Home:
Signature:
Date:
Page 3 of 4
Photo Release Waiver
I acknowledge that photographs will be taken of my child on Wednesday February 17, 2016, by a photographer
and/or videographer acting on behalf of the University of Western Ontario (“Western University”) in connection
with the 11th Annual Track & Field Day program being hosted by Western University and Indigenous Services at
Thompson Arena.
Western University collects personal information under the authority of the University of Western Ontario Act,
1982, as amended. The information is related directly to and utilized by Western University for the purposes of
recruitment, program development, administration, and other activities related to its programs.
The information may be used by Western University in curriculum, course materials or publications such as, but
not limited to: printed publications, poster displays, electronic publications and websites, external media or other
promotional media that support Western University’s initiatives and programs.
On behalf of my child, I give to Western University the exclusive permission for no charge to use any photographs
taken of my child at Thompson Arena on Wednesday February 17, 2016, by the photographer acting on behalf of
Western for reproduction by Western in its program materials or other published materials and initiatives
consistent with Western’s educational purposes.
Name of Child:
_______
Parent/Guardian Name (Please Print):
______________ ___________________________
Signature:
_________
Date:
_______
Page 4 of 4