York Catholic District School Board

INFORMED CONSENT/PERMISSION FOR EDUCATION TRIPS

ELEMENTS OF RISK: GENERAL
(Pupils Under 18 years)


ST. BROTHER ANDRE CHS is arranging
(name of school)

The Science of Rock and Roll at the Ontario Science Centre on October 17
th
, 2014
(description of activity and dates)

THIS FORM MUST BE READ AND SIGNED BY EVERY PUPIL WHO WISHES TO PARTICIPATE, AND BY A
PARENT OR GUARDIAN OF A PARTICIPATING PUPIL.

ELEMENTS OF RISK

Educational activities that take place outside of the school involve certain elements of risk, some of which are
connected with transportation and traffic. Accidents may occur while participating in activities or while being
transported to and from educational destinations outside of the school. These accidents result from the nature of
the activity and can occur without any fault on either the part of the pupil, or the School Board, or its employees or
agents, or the transporter, or the facility where the activity is taking place. By choosing to participate in the activity
you understand that you are assuming the inherent risk of the activities.

The chance of an injury occurring can be reduced by carefully following instructions at all times while engaged in
the activity.

The York Catholic District School Board does not provide accidental death, disability, dismemberment or medical
expense insurance on behalf of the pupils participating in this activity. If you do not have this type of coverage, you
may purchase Pupil Accident Insurance through the Boards provider at www.insuremykids.com, or by calling toll
free at 1-800-463-5437.


ACKNOWLEDGEMENT

WE HAVE READ THE ABOVE. WE UNDERSTAND THAT IN PARTICIPATING IN THE ACTIVITY DESCRIBED
ABOVE, WE ARE ASSUMING THE RISKS ASSOCIATED WITH DOING SO.

Signature of Pupil:_______________________________________________ Date:______________________


Signature of Parent/Guardian:________________________________________ Date:______________________


PERMISSION

I give __________________________ permission to participate in the Science of Rock and Roll Field Trip
(name of pupil) (description of activity)

to be held on or about October 17
th
, 2014



Signature of Parent/Guardian:________________________________________ Date:______________________

Admin 75
Rev. Feb. 2010
RM#: L03

October6
th
,2014

DearParentsandGuardians

OnOctober17
th
,grade9instrumentalandvocalmusicstudentswillbewelcometovisittheOntario
ScienceCentretoviewtheScienceofRockandRollExhibit.Heretheywillhavetheopportunityto
explorethehistoryofmusicfromascientistsperspective,exploringtopicssuchasthepsychologyof
musicandthephysicsofmusic.

HereistheitineraryforFriday,October17
th
,2014.
9:00am DepartSt.BrotherAndre
10:00am ArriveattheOntarioScienceCentre(770DonMillsRoad,Toronto,ONM3C1T3)andtour
theScienceofRockandRollexhibit
11:45m LunchattheOSC.Studentstobringmoneytouseonsite
12:30pm Studentsmayviewotherexhibits
1:30pm DepartOntarioScienceCentre
2:30pm ExpectedreturnatSt.BrotherAndretoboardschoolbusses.Aswearetravellingonthe
highway,pleasebepreparedtomakealternativepickuparrangements.
*Cost $10.00cashorchequepayabletoSt.BrotherAndreCHSdueonOctober10
th
,2014
coversadmission

WelookforwardtotheGrade9musicstudentsfirstfieldtripasacommunity.Pleasefilloutthe
attachedpermissionformandreturnalongwithpaymentbyOctober10
th
,2014.

Thankyoukindly,

Mr.S.Jannetta Ms.N.Barcena
MusicTeacher MusicTeacher