Take Our Kids To Work Day 2024

Take Our Kids To Work Day 2024 - In-Person

November 6, 2024.
Please know that this form includes Alberta Health Services, Alberta Precision Labs, and Recovery Alberta site and staff requests.

This form is to be filled out by the interested student and their parent/guardian.

We are excited for the Alberta Health Services (AHS) Take Our Kids To Work Day 2024.

This in-person event is for High School students who are interested in learning more about the career of a parent, guardian or AHS/APL employee working in healthcare.

At the end of this form, we will require an electronic signature from:
- the student/participant
- parent/guardian and
- AHS Employee Host (if different from parent/guardian).
You will be sent your confirmation, further information, and all other communication to the email that is submitted below.

Please note that attendees may be exposed to real medical situations, medical images, and information that some may find graphic and disturbing.

For more information, please contact youth.careers@ahs.ca .

Let’s get started:
Student Information
Student Name*

First NameLast Name
Student email (best email to send participant information) *
example@example.com
Name of school (no acronyms please):*
No acronyms please.
Are you willing to participate in an interviewed for a web story about your experience that may be shared in our AHS newsletters?

YesNo

AHS Employee Host Information

This may be a parent, guardian or an AHS/APL employee who has agreed to host you for the day.
Name of AHS Employee Host *

First NameLast Name
Work Phone Number*
Please enter a valid phone number.
AHS Employee Host Email (please ensure email is spelled correctly as approval is sent via email)*
example@ahs.ca
Position Title of AHS Employee (no abbreviations)*
Registered Nurse, Human Resources Advisor, Manager etc.
AHS Zone*
AHS Site (no abbreviations)*
Milk River Health Centre, Royal Alexandra Hospital etc.
Department/Unit (no abbreviations)*
Registered Nurse, Human Resources Advisor, Manager etc.

Is your AHS Host also your parent/guardian? Please note your parent/guardian is not required to be an AHS Employee for you to attend.*

YesNo

Parent/Legal Guardian Information
Parent/Legal Guardian Information

First NameLast Name
Phone Number
Please enter a valid phone number.
Parent/Legal Guardian Email
example@example.com

Department Manager Information

An approval request will be sent to the department Manager via this email. Take Our Kid To Work Day request cannot proceed without Manager approval.
Manager's Name*

First NameLast Name
Manager's Email (please ensure the email address is spelled correctly as this is sent directly for approval via email)*
example@example.com

Consent, Release of Liability & Confidentiality Agreement (the “Agreement”)

AHS is providing an opportunity for Grade 9-12 students to observe their parents/legal guardian or AHS employee hosts at work for one day. As the healthcare environment is likely an unfamiliar workplace for students, the parent/legal guardian and AHS employee host (set out above) must ensure that the Student is aware of and complies with AHS policies, directives and practices, especially those that refer to confidentiality and safety.

Please read the following carefully.
1. I would like to participate and host the Student for the “Take Our Kids To Work™” day at AHS.
2. I agree that it is my responsibility to ensure the Student complies with all AHS policies especially those related to confidentiality and safety. I will explain to the Student that AHS has a legal and ethical responsibility to safeguard the privacy of all patients/residents/clients and to protect the confidentiality of their personal information. The Student agrees to abide by the AHS policies and procedures concerning confidentiality and release of information.
3. I understand the Student must keep all personal and health information private and confidential.
4. I will not allow the Student to observe any patient/client or AHS employee without first receiving the patient/client or AHS employee’s prior consent. I understand that I am responsible for the Student while on AHS premises and I accept personal liability for any improper conduct of the Student, including but not limited to any breach of privacy or confidentiality.
5. I understand the benefits and risks involved in the “Take Our Kids to Work” Program (the “Program”).
6. I understand participation in the program is voluntary and I freely accept and fully assume all such risks, and the possibility of personal injury and damage or loss to personal property because of taking part in the Program. In consideration of AHS offering the activity, I agree as follows:
  1. To waive and release all claims that I or the Student have or may have in the future against AHS and its board members, employees, agents, volunteers, and independent contractors (collectively referred to as
    the "Releasees"), as a result of my participation or the Student’s participation in the Program due to any cause including negligence, breach of contract, or any other duty of care but excluding any negligence on the part of AHS or any Releasee
  2. To hold harmless and indemnify the Releasees from any and all liability for any property damage or personal injury to me, the Student or any third party resulting from participation in the Program; and,
  3. That this Agreement is effective and binding upon myself, my minor child named as the Student, and each of our respective heirs, next of kin, representatives and assignees.
7. I understand that in order to participate in the Program, the Student must have received the Rubella vaccine and that it is also strongly recommended that the Student have the following vaccinations and/or immunizations: Pertussis (Whooping Cough), Tetanus + Diphtheria, Measles, Mumps, Polio, Hepatitis B, Varicella (Chickenpox), Seasonal Influenza and Tuberculosis skin test.
8. In entering into this Agreement, I am not relying upon any representations or statements made by AHS other than what is set forth in this Agreement. I also understand that I can seek independent legal advice before entering into this Agreement and confirm I have either obtained such legal advice or have voluntarily waived that right.
I have read and understand this Agreement. I agree with the terms of this Agreement and confirm my agreement by signing in the space below. I am aware that by signing this Agreement I am waiving certain legal rights, including the right to sue, which I, my child and our respective heirs, next of kin, representatives and assignees may have against AHS and/or Releasees.
Parent/Legal Guardian Signature*

Clear
Date*

MonthDayYear
Date
AHS Employee Host Signature

Clear
Date

MonthDayYear
Date
Student Signature*

Clear
Date*

MonthDayYear
Date
Upon agreeing below, an email will be sent to the Manager indicated, sharing the same information:

By agreeing below, the you certify that you will:
• review the content of this Agreement with the Student/participant and the Manager will reivew the content of this Agreement with the AHS Employee (Parent/Legal Guardian/AHS Employee Host);
• determined that the Employee’s work area is a suitable environment for participation in Take Our Kids To Work™ day; and
• discussed directly with the Employee any specific work area restrictions regarding participation in the Take Our Kids To Work™ day
Should be Empty:

Take Our Kids To Work Day 2024 - In-Person

Student Information

AHS Employee Host Information

Parent/Legal Guardian Information

Department Manager Information