April 1, 2015
Dear students and parents,
The major field trip for the SPH 3U, SPH 4U and SPH 4C first and second semester
courses is a trip to Canada’s Wonderland on Wednesday May 27, 2015. The price for the trip per
student will be $70.00. This includes entry into Canada’s Wonderland as well as the transportation
there and back. The students will provide or buy their own lunch, snacks, drinks etc. We will be
departing from the school at 7:45 a.m. sharp and arrive back around 8:00 - 8:30 p.m. depending on
the traffic.
If any parent wishes to join us as a chaperone, please send a note with your child’s
permission form stating your name, phone number and a convenient time to call you. Do note that
a police check for all chaperones must be on file with the school by the date of the trip. Chaperones
will be required to pay the $70.00.
Permission form and money are due to your physics teacher by April 10, 2015.
Thank you,
S. Gregorio and R. LoRusso
Educational Field Trips and Excursions
Informed Consent Form for Parents
School:
Mother Teresa Catholic S S
Teacher-in-Charge: Susan Gregorio
Destination:
Canada's Wonderland
Grade:
11 and 12
Date of Return:
27-May-2015
Date of Departure: 27-May-2015
Time of Departure from School:
7:45 AM
Cost per Student:
$70.00
Approximate Time of Return to School:
8:00 PM
Number of Students:
150
Method of Transportation:
Bus
Name of Volunteer Driver: Murphy Bus Lines
Number of Supervisors: 10
Educational Purpose of Trip
To collect data and observe the physics of motion as it applies to amusement park rides.
Additional Information:
Mother Teresa Catholic S S
To the London District Catholic School Board and the Principal of _______________________________________________________________________.
As the parent(s)/guardian(s) of ______________________________________________________________________(Please print name of student in full)
Canada's Wonderland
I hereby request that the our son/daughter be permitted to participate in the trip/excursion to _____________________________________________
Please note: No eligible student will be denied participation on an inclusive field trip due to lack of finances. Any inquiries related to this field trip should
be directed to the school Principal.
All field trips and excursions are approved and conducted in compliance with school board policy: http://www.ldcsb.on.ca/Policies/I-5-1-Field-Trips.pdf.
Care is taken to ensure adequate safety procedures are in place for all school activities. In the event of an emergency, the Crisis Response Protocol (Safe
Schools Policy - Code A 3.3) shall be implemented: http://www.ldcsb.on.ca/Policies/A-3-3-Safe-Schools.pdf. Educational activity programs such as
sporting events, field trips, excursions or other such activities may present various elements of risk. Helmets are mandatory equipment when required.
Accidents and injury may result from the nature of the activity and can occur without any fault on either the part of the student, or the London District
Catholic School Board or its employees or agents. By choosing to participate in the activity, I am assuming the risk of an accident and I understand that I
will bear the responsibility for an accident or injury that might occur. The London District Catholic School Board does not provide any accidental death,
disability, dismemberment or medical expenses insurance on behalf of students participating in the activity. Participants must assume these risks.
I have read the information contained in this Informed Consent for Parents. I understand the nature of the trip, method of transportation and the use of a
volunteer driver named herein. I give permission for my child to participate in the trip described in this document. I also acknowledge that by permitting
my child to participate in this activity, I am assuming the risks in doing so.
Name of Parent or Guardian (Please Print):
Signature of Parent or Guardian:
Date:
"Pursuant to the Municipal Freedom of Information and Protection of Privacy Act, personal information on this form is collected under the
authority of the Education Act and Ontario Regulations. It will be used for purposes related to the identified educational field trip/excursion and
will be retained for 3 years. Questions about the collection of this personal information should be directed to the School Principal."
Educational Field Trips and Excursions
Direction and Authorization Form
This Direction and Authorization pertains to:
The Child:
Child's Full Name:
Birth Date:
The Parent(s) / Guardian(s)
Parent's Full Name:
Relationship to Child:
Address:
Contact Details:
Teacher-in-Charge: Susan Gregorio
In case of an accident, the Principal, teacher or whomever they may designate in charge of the excursion must have the freedom to take
the injured student to a medical doctor or emergency services. By signing this form, you permit the teacher-in-charge, if necessary,
to seek medical assistance to your son or daughter.
I authorize the Teacher-in-Charge to seek general first aid treatment for minor injuries or illnesses experienced by my child.
I authorize the Teacher-in-Charge, in the event that I cannot be contacted or if any urgency dictates, to act in loco parentis for my child in
respect of any circumstances, including any accident or illness, which may necessitate medical treatment, including surgery, and on my
behalf to authorize any such treatment or surgery which they, in their sole discretion, (which discretion shall not be unreasonably
exercised), may deem necessary. Medical treatment for my child may also include dental surgery, x-ray, blood transfusion, anesthetic and
medication provided any such medical treatment is performed by a duly licensed practitioner. I hereby accept full liability for all costs
incurred through such medical treatment for my child.
Please List Any Medical Concerns (i.e. allergies, epilepsy, seizures)
Family Doctor:
Phone Number:
I declare that I am the legal custodian of the Child and that I have legal authority to grant medical consent to the Temporary Guardian for
the Child.
27
May
15
This medical consent will be in effect from the _______
day of ___________________20__
27 day of ______________________20__.
May
15
until the _____
Signed at ______________________on this ______day of _________________20____
Signature of Parent:
Signature of Parent:
"Pursuant to the Municipal Freedom of Information and Protection of Privacy Act, personal information on this form is collected under the
authority of the Education Act and Ontario Regulations. It will be used for purposes related to the identified educational field trip/excursion and
will be retained for 3 years. Questions about the collection of this personal information should be directed to the School Principal."