Eve rgre e n Grade 2 an d Fire fly Clas s e s
Ke n o ra Bo wlin g Alle y
On TUES DAY J UNE 9 , 2 0 1 5 t h e Eve rgre e n Grade 2 an d Fire fly c las s e s will be bu s s e d t o t h e
Wh it e Cap Pavilio n an d t h e n walk t o t h e Ke n o ra Bo wlin g Alle y . Th ey will lea ve E ver gr een a t
a p p r ox. 1 0 :0 0 a m a n d r et u r n b y 1 :0 0 p m . It will b e s u p er vis ed b y Mr s . Fren et t e a n d Mr s .
Bou ch a . In or d er t o p a r t icip a t e, t h is fo rm m u s t be re ad an d s ign e d b y ever y s t u d en t wh o
wis h es t o p a r t icip a t e a n d b y a p a r en t or gu a r d ia n of a p a r t icip a t in g s t u d en t .
 There is a $5 fee for the Bowling Alley. This fee covers shoe rental and games
*******NOTE: NO FLIP-FLOPS *******
Ele m e n t s o f Ris k
E d u ca t ion a l Act ivit y Pr ogr a m s s u ch a s field t r ip s in volve cer t a in elem en t s of r is k . Accid en t s m a y
occu r wh ile p a r t icip a t in g in t h es e a ct ivit ies a n d t h es e a ccid en t s m a y ca u s e in ju r y. A few
exa m p les of t h e t yp e of a ccid en t t h a t m a y occu r a r e : s lip a n d fa ll, or t r a ffic a ccid en t .
Th es e t yp es of a ccid en t s r es u lt fr om t h e n a t u r e of t h e a ct ivit y a n d ca n occu r wit h ou t a n y fa u lt on
eit h er t h e p a r t of t h e s t u d en t or t h e S ch ool Boa r d or it s em p loyees or a gen t s , or t h e fa cilit y wh er e
t h e a ct ivit y is t a k in g p la ce. By ch oos in g t o p a r t icip a t e in t h e a ct ivit y, you a r e a s s u m in g t h e r is k
of a n a ccid en t occu r r in g.
All r ea s on a b le s a fet y p r eca u t ion s will b e t a k en a n d t h e r is k of in ju r y ca n b e fu r t h er r ed u ced b y
t h e s t u d en t ca r efu lly followin g in s t r u ct ion s a t a ll t im es .
Keewatin-Patricia District School Board does not provide any accident insurance coverage for student
injuries that occur on school premises or during school activities. You may purchase coverage for
your child at www.insuremykids.com or by calling toll free at 1-800-463-KIDS (5437).
Plea s e in d ica t e on t h e for m t h a t is b ein g r et u r n ed t o t h e s ch ool or con t a ct u s p er s on a lly if t h er e is
s om e a s p ect of you r ch ild t h a t we s h ou ld b e a wa r e of a n d a n y p r eca u t ion s t h a t s h ou ld b e t a k en .
PERMIS S ION FORM
I give
pe rm is s io n t o part ic ipat e in t h e fie ld t rip t o t h e Wh it e
(S t u d en t ’s n a m e)
Cap Pavilio n an d Bo wlin g Alle y o n Tu e s day J u n e 9 , 2 0 1 5 an d as s u m e all t h e ris ks
as s o c iat e d wit h it .
(S ign a t u r e of p a r en t (s ) / gu a r d ia n (s ))
I h ave re ad t h e abo ve in fo rm at io n wit h m y pare n t (s )/ gu ardian (s ). I u n de rs t an d t h at
t h e re are s o m e ris k s in vo lve d an d I will do e ve ry t h in g re as o n able t o c o m ply wit h t h e
s afe t y o rie n t e d re gu lat io n s an d in s t ru c t io n s in o rde r t o re du c e t h o s e ris k s .
(S ign a t u r e of s t u d en t )