FIELD TRIP PARENT PERMISSION
DETAILS OF THE TRIP
School Belgo Elementary
School Phone No
250 765 8900
Teacher Contact
Jean-Yves Pineault
Destination
Kel. Fam.YMCA in Rutland
Purpose of Trip Swimming
Description of Activities (please attach further detailed information as needed):
The students will walk to the Kelowna Family YMCA in Rutland, participate in a one hour free swimming period,
and walk back to school. There will be 3 trips on the following days: June 3, June 10 and June 17. In addtion to
these 3 trips, we will have a 4th swimming trip to the H2O pool on June 24. The students will travel by bus to the
H2O pool, swim for 2 hours, and return to school by bus. The cost of the first 3 trips is payed by PAC (Thank
you!). The cost of the last trip to H2O will be: $8
Inherent Risks of Participating:
Any risks associated with walking beside a road and swimming in a pool, including falling, slipping on the
pool deck, drowning, pedestrian or vehicular accident and separation from the group.
Group of Students: Mr. Pineault’s, Mrs. Huculack’s, Mrs. Vammen’s and Mrs. Greenberg’s classes
No. of Students 100
No. of Teachers/Supervisors
6
RUTLAND KELOWNA FAMILY WMCA: (3 trips)
Departure Dates (M/D/Y) )(06/03/15) (06/10/15) (06/17/15)Departure Time
12:00 p.m.
Return Dates(M/D/Y) )(06/03/15) (06/10/15) (06/17/15)Return Pick-Up Time
1:45 p.m.
Arrival Time Back at School
2:20 p.m.
H2O: (1 trip)
Departure Date (M/D/Y) ) 06/24/15
Departure Time
11:00 a.m.
Return Date(M/D/Y) ) 06/24/15
Return Pick-Up Time 1:50 p.m.
Arrival Time Back at School
2:20 p.m.
TRANSPORTATION:
School District Bus
[ X ] (H2O, June 24)
Wheelchair Access [ ] City Transit
[ ] Private
Rented Vehicle
[ ]
Commercial Carrier [ ]
Foot[ X ] ( Rutland Pool, June 3, 10, 17)
Driven by:
District Driver [ X ] (H2O, June 24)
Teacher [ ]
Authorized Student Driver (no passengers allowed) [ ]
Commercial Driver
[ ]
PARENT/GUARDIAN CONSENT:
I have read the description of activities, understand that there are inherent risks attached to this activity and
accept these risks. I also understand that all of the requirements of the school Code of Conduct apply while
students are on field trips, and I will repay the school for costs if it is necessary to send this student home by
means other than as stated above.
Consent is given for my child to participate and travel as described. (YMCA Rutland & H2O Swimming)
Name
Student’s BC Medical #
Medical concerns, allergies, medication requirements
Signature
Date
Attachments:
 Yes
 No
(including any special requirements in order to participate)
Form 525.2
Date Agreed: September 2004
Date Amended: March 28, 2007