École secondaire Oak Park High School provides a safe, inclusive, and engaging learning environment which nurtures exceptional character, and inspires excellence in academics, the arts, and athletics.
L’École secondaire Oak Park High School se consacre à fournir un environnement d’apprentissage sécuritaire, inclusif, et engageant qui favorise un caractère moral exceptionnel et de l’excellence dans l’académique, les arts, et l’athlétisme.
Informed Parental/ Guardian Consent
Please complete this page and return it to the supervising teacher at your school.
Having read and understood the information regarding the Oak Park Bandtrip to Banff, AB, I/we, ______and______(print name of custodial parent here) (print name of custodial parent here)
do hereby authorize the teacher and chaperones designated by Pembina Trails School Division to travel with my/our child ______to
(print name of child here)
Banff, ABto participate in the Rocky Mountain Music Festival. I understand that the tour leaves on April 10thand returns on April 15th 2018and that while on tour my/our child must adhere to a Code of Conduct (under separate cover).
Further, I agree to be financially responsible for all debts incurred by my child either in preparation for or during the excursion. This includes, but is not limited to, any cost associated with returning the student and an accompanying chaperone to Winnipeg if necessary.
I/We also authorize the chaperones to seek and secure medical services as deemed necessary for the health and safety of my/our child.
In case of emergency, please contact
Name: ______(relationship to student) ______
Bus. Phone: ______Home Phone: ______
Cell Phone: ______
______
Signature of parent/guardian Print name of parent/guardian
______
Date Date
PERSONAL MEDICAL HISTORY & MEDICAL INSURANCE
The following personal medical information is being collected to better support and protect Pembina Trails students while on this extended tour. All information is considered confidential and will only be shared with the chaperones, school and medical professionals as required.
Student Name: ______
Birthdate (M/D/Y) ___/___/___
Manitoba Medical Personal Identification Number: ______
Medical Insurance Provider: ______
Medical Insurance Policy Number: ______
*****A copy of your medical insurance policy and number is required.
Doctor’s Name: ______
Doctor’s Contact Information: ______
Please identify any health information that we need to be aware of (including any prescription medication): ______
______
Please identify who to contact in case of a medical emergency:
Name: ______Phone: ______
Name: ______Phone: ______
CODE OF CONDUCT
PRINCIPLE OF PERSONAL INTEGRITY – Remember that you always represent yourself, your school, Pembina Trails School Division, your community and your country. Never allow yourself or any member of the group to be put in a compromising situation. At all times, please be respectful of others.
In order to ensure that I will derive the greatest benefit from this experience and to help ensure the safety and security of all participants, I agree to the following Code of Conduct during all preparatory sessions and the trip itself:
- I will not use alcohol or drugs (other than those prescribed by a physician). This includes free time as well as scheduled programs.
- I will not use tobacco or vape products in any form. This includes free time as well as scheduled programs.
- I will respect all areas that are considered off limits.
- I will participate in all programs.
- I will be on time for all events.
- I will remain with the group at all times (except during designated free times when I must be in groups of three or more), and I will not leave the group without a chaperone’s permission.
- I will report any accident, injury, or illness (whether it is myself or another group member who has been injured or become ill) immediately to a chaperone.
- I will abide by the curfew as established by the chaperones.
- Students will not visit any other rooms after curfew. Participants are expected to respect themselves and others and to behave appropriately.
- I will not leave the hotel without permission nor unsupervised.
- I will report immediately the loss of any personal item(s) or documentation.
I understand that violation of any of these rules can result in disciplinary action. I acknowledge that the chaperones of the Banff tripare authorized in all instances of inappropriate behaviour to make whatever decisions are necessary to ensure the safety of participants, and the success of the trip, including being removed from the trip prior to departure or, once on tour, being sent home at my or my family’s expense.
I also understand that all rules, regulations, policies, and guidelines for student conduct, as set out in the Pembina Trails Standards of Behaviour document will apply while on this trip.
I further understand that participation in the Banff Band Trip will mean that I will be absent from school for several days and that it is my responsibility to inform my teachers and to make up any work missed during my absence.
______
Print name of participant
______
Signature of Participant Date
Parental Acknowledgement of and Agreement with the Code of Conduct
I have read the Code of Conduct for the Rocky Mountain Music Festival Banff Trip, and fully understand that my child’s participation in this program is contingent on his or her adherence to these rules, and that failure to do so can mean removal of my child from the trip prior to departure.
I understand that all rules, regulations, policies, and guidelines for student conduct, as set out in the PT Standards of Behaviour document will apply while on this trip.
I understand that if the chaperones agree that my child must be sent home for any reason, I will be responsible for all costs associated with this action.
I also understand that participation in the Banff Band Trip will mean that my child will be absent from school for several days. I realize that all tutorial or remedial assistance for my child is my responsibility, and that my child must notify and speak to all teachers concerned prior to departure to ensure proper catch-up of all missed work, tests, assignments, projects, etc.
I have read, understood, and agree to all of the conditions indicated.
Please note that consent from ALL custodial parents is necessary
______
Print name of parent/guardian Print name of parent/guardian
______Signature of parent/guardian Signature of parent/guardian
______
Date Date
Prior to getting on the bus, I will check my child’s luggage, backpack etc. and ensure that there is nothing accompanying him on this trip that would breach this code of conduct.
Prior to getting on the bus, I prefer you check my child’s luggage, backpack etc. to ensure that there is nothing accompanying him on this trip that would breach this code of conduct.