Zoo Field Trip Permission Slip Kindergarten Students ... - Retsd.mb.ca

Wayoata Elementary School
605 Wayoata Street,
Winnipeg, Manitoba, Canada
R2C 1J8
Phone: (204) 958-6840
Email:way@retsd.mb.ca
Principal: Mrs. K. Cressall
Web Site: http://www.way.retsd.mb.ca Fax: (204) 222-5053
PARENTAL INFORMED CONSENT FOR OUT-OF-SCHOOL ACTIVITIES Page 1 of 2
Name of Program/Activity:
Description of Activities:
Destination:
Students Participating:
Purpose of Program/Activity:
Date & Time of Departure:
Date & Time of Return:
Staff Members in Charge:
Mode of Transportation:
Trip to the Zoo
A study of animal behaviour and habitats.
Assiniboine Park Zoo
All Kindergarten, Grade 1 and 2 Students
The study will complement the science curriculum.
Wednesday June 12, 2013 9:30 a.m.
Wednesday June 12, 2013 2:30 p.m.
Ms. Johnson, Miss Moore, Mrs. Frank, Mrs.Copeland, and Mrs. Hall
R.E.T.S.D. Bus
Cost of Activity: $7.50
Date Permission Slip & Money Due: May 29, 2013
Other Information:
ALL KINDERGARTEN students will attend school on June 12, 2013 for
the whole day, from 8:30 a.m. to 3:15 p.m.
Along with a tour of the zoo, we will be visiting the playground and having a
picnic lunch.
Students may wear runners or sandals - but no flip flops, or shoes that
may ‘fall’ off.
This is an outdoor activity and children should be appropriately dressed for
the weather conditions. Safety Guidelines For Physical Activity in Manitoba
Schools recommends that students should be suitably protected against the
sun, heat and insects. Depending on the sunscreen, it is recommended that
sunscreen be applied up to two hours before taking part in outdoor activities.
Please apply sunscreen and insect repellent before sending your child(ren) to
school. Students may bring sunscreen to school so that it may be re-applied
during the day.
Items student is required to bring:
Cancellation Information:
Students should have the items that they need (lunch, drink(s), refillable
water bottle, hat and sunscreen) packed in their back packs, as they will be
responsible for carrying these items.
In the case of inclement of weather, this field trip will be cancelled.

PARENTAL INFORMED CONSENT FOR OUT-OF-SCHOOL ACTIVITIES Page 2 of 2
Board Responsibilities:
The board will make every reasonable effort through the application of its policies and procedures, to
provide for thorough preparation and planning and implementation of out of school activities undertaken
by its employees, agents and officers.
Informed Consent
Activity Title:
Trip to the Zoo
Date of Activity: Wednesday June 12, 2013
Name of Student (please print): ________________________________________________________
I/We, the undersigned, hereby acknowledge that certain risks of injury are inherent in the participation in sports,
recreational activities and other off-school site programs. These types of injuries may be minor or serious.
I/We understand that, in case of emergency medical or hospital services being required by the above-listed participant,
and with the understanding that every reasonable effort will be made by the school/hospital to contact me, my signature
on this form authorizes the board, through its employees, agents, and officers, [to] secure such medical advice and
services as they deem necessary for my child’s health and safety, and that I shall be financially responsible for such
advice and services.
I/We understand that the Rules and Regulations pertaining to this activity are designed for the safety and protection of
participants.
I/We acknowledge my right to obtain as much information as I require about this program or activity and associated risks
and hazards, including information beyond that provided to me by the school.
I/We acknowledge that it is my responsibility to advise the school of any medical and/or health concerns of my child that
may affect his/her participation in the stated program or activity.
I/We understand that the choice to participate brings with the individual the ASSUMPTION OF RISK which is part of those
activities.
I/We understand and agree that this is a part of the school program. I/We also understand that as a result of participating
in this program that the participant is expected to follow the school procedures and code of conduct and that any
deviations from these may result in consequences from the school administration.
I/We declare having read and understood the above INFORMED CONSENT AGREEMENT in its entirety and hereby
consent to participate being aware of all the foregoing.
Parent/Guardian Signature
Date
In order for your child to participate in this event, this signed consent form must be received
at the school before the event.