T.A. Blakelock High School
Car Trip Notification & Permission Form
Please keep this portion handy for reference.
To parents of class: ______
Location & Description:______
Subject Area______Number of Students Attending ______
Purpose of Trip______(curricular tie-in)______
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______
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Date of trip:______Cost per student: ______
Departure Time: ______Return Time: ______
Teachers involved: ______
Items Required: r Lunch r Water / Sunscreen r Bag / Knapsack r Outdoor Clothing r Rain Gear
Volunteers are not required: r OR Volunteers are required for r Driving r Supervision
Reminder: All volunteers need to have a Criminal Record Check including a “Vulnerable Sector Screening” completed.
Other information: ______
______
______
Trip Coordinator Principal
NOTE: Any out of school experience may involve extra hazards beyond those of normal school routines. Please reinforce the counselling given at the school about the need for extra care and cooperation.
According to Provincial legislation, passengers who are injured would recover Accident Benefits coverage from their own or a parent’s automobile policy. In the absence of a personal or family automobile policy, the passenger would then be eligible to recover benefits from the insurance policy covering the vehicle in which they were riding.
Please detach and return permission and payment before: ______
I give permission for my son/daughter named below to participate in the following field trip:
To: ______Date of trip: ______
Student’s Name: ______Class / Group: ______
Amount enclosed: ______r Cash r Cheque r Payment made through Cashless Schools
Medical Information: Please indicate any medical information of which the teacher should be aware.
______
______Health Card # ______
Parent’s Daytime Phone #: Name ______Telephone Number ______
r Yes r No The medical information about my child has changed since September.
r Yes r No If “yes”, I require a new Medical Information form to give the information to the office.
Volunteers: I would like to volunteer as a: r Supervisor r Parent Driver r Student Driver (secondary schools only)
For volunteer drivers: I warrant that my vehicle is properly insured ($1,000,000 liability) and maintained, and that I am licensed
to drive in the Province of Ontario. I warrant that each child at least 8 years of age or weighing 80 lbs or taller than 4 feet 9 inches
will be properly secured by a seat belt. Otherwise, I warrant to provide a child seat or booster seat for each child as required.
Each volunteer driver will be required to complete and sign the Driver List for Day Field Trips form provided by the school.
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Parent Signature Telephone number