Field Studies Permission Form
Elsie Roy Elementary School
150 Drake Street, Vancouver, BC. V6Z 2X1
Telephone: 604 713 5890
The purpose of this form is to inform you about a proposed field studies involving your child, and to seek your support and permission for your
child to participate. Field studies are part of the school program and they provide students with valuable learning experiences. However, should
you not wish your child to participate in this activity, school staff will assign the student other learning activities at the school. This is an
important document. Please review the contents of this Consent and Acknowledgement of Risk form carefully prior to providing
permission for your child to participate in this excursion. Clarify any questions or concerns with the Lead Teacher BEFORE signing it.
Please keep this form for your information and only return the signed consent portion.
Division(s): 1 & 2 Lead Teacher: Tyrel Meredith Other Staff: Erica Sullivan
Date & Time of Field Trip: December 16th @ West End Community Center
Location, Activities, Holiday skating
Program:
Purpose and Supporting our Physical and Health Education program. Team
Educational Goals: building.
# of Supervisors: __8__ Teachers and parent volunteers.
Supervision Arrangements:
Leave School At: 8:45 am Return To School At: 12
pm
Method(s) of Public transit (Davie bus) and walking.
Transportation:
Students Must Bring: Walking shoes, snacks, umbrella, gloves, skates (if available),
helmet (if available).
Other Information: All students on the ice must wear a helmet.
Behaviour Expectations: Students are expected to abide by the rules and regulations, including directions and instructions, of the
school’s or service provider’s staff over all phases of the program/activity and follow Elsie Roy’s Code of
Conduct – ORCAS - Ownership Respect Compassion Achievement Safety
Volunteers Needed? c Yes Number of Volunteers: c No
Cost: PLEASE PAY $4
ONLINE
The board will make every reasonable effort to ensure or ascertain that: the staff, volunteers and/or service providers involved are suitably trained and qualified; the
students are adequately supervised over all aspects of the program/activity; the location(s) used are appropriate and safe for the activity(ies) and group; equipment
used has been inspected and deemed appropriate and safe; a Safety Plan is in place to identify and manage known potential risks; an Emergency Plan is in place to
deal with an injury or illness to any students. Students are expected to wear helmets for cycling, rollerblading, downhill skiing, snowboarding, skating, rock climbing
and white-water activities. Students are expected to wear a properly fitted Personal Floatation Device in or around the water when participating in water-based
activities other than swimming.
While the school will take reasonable steps to prevent injuries to students, some degree of risk is inherent in the nature of this activity and may occur with or without
fault on the part of the student, school board, its employees or agents, and/or the facility where the activity is taking place. By allowing your child to participate in this
activity, you are agreeing that the activity described above is suitable for your child, and that there is a risk of injury associated with the activity. Safety issues and
precautions will be discussed with students. Students will be required to wear any safety equipment specific to the planned activity (e.g. goggles, helmets or
personal floatation devices when applicable).
________________________________ ___________________________________
Teacher Principal/Vice Principal
Consent and Acknowledgement of Risk
While school staff will take reasonable steps to prevent injuries to students, some degree of risk is inherent in the nature of this activity, and
may occur without fault on the part of the student, school board, its employees or agents, or the facility where the activity is taking place. By
allowing your child to participate in this activity, you are agreeing that the activity described above is suitable for your child, and that there is a
risk of injury associated with the activity.
c My child has been informed that he/she is to abide by the rules and regulations, including directions and instructions from the school’s and/or
service provider’s administrators, instructors, and supervisors over all phases of the program/activity.
c In the event my child fails to abide by these rules and regulations, disciplinary action may require his/her exclusion from further participation, or
that I be contacted to have him/her picked up, unless I have specified other transport arrangements.
c I acknowledge that the trip supervisors may secure transport to emergency medical services as they deem necessary for my child's immediate
health and safety, and that I shall be financially responsible for such services.
I, __________________________ (Name of Parent/Guardian) would like my child ________________________
in Div. ____ to participate in the field study described above on the following date: ________________. I understand that
my child may be exposed to a risk of injury due to accident while participating in this activity.
Signature:___________________________ Name: ________________________ Date: ___________
Comments: ___________________________________________________________________________
(Please include any restrictions or limitations which would prevent your child from fully participating in this trip, or any other special
concerns which school staff should be aware of surrounding your child’s participation. Use reverse side if necessary.)
I can volunteer for this trip Yes ___ No ___
I have paid online (https://www.schoolcashonline.com). My receipt number is: ____________________
No student shall be denied an opportunity to participate in an activity because of financial hardship. Please contact the Principal/Vice Principal if you have questions or concerns regarding the costs listed above.
