PARENT/GUARDIAN CONSENT AND ACKNOWLEDGEMENT OF RISK

Dear Parent(s)/Guardian(s)

Please read the contents of this Consent and Acknowledgement of Risk form. Clarify any questions or concerns with the Lead Teacher BEFORE signing it.

As mentioned in the Registration Package, we are implementing a $10 athletic fee for each athlete per sport. This is to help the school cover the increasing cost of athletic fees with CISVA and other organizations that host events. The $10, for all WINTER ATHLETICS events, will come out of your account via EFT on (Dec 16th, 2024) if you have signed a permission form. If this fee is a hardship for your family then please contact the office to speak with Mr. Heah. If this permission is not signed and returned to the school your child WILL NOT BE ALLOWED TO

Date Form Must be Returned by:

Program/Activity Information (Basketball, beginning the week of Nov 4th)

Destination: CLOVERDALE CATHOLIC SCHOOL AND CISVA SCHOOL

BUILDINGS, GYMS, FIELDS, and PARISH BUILDINGS.

Date: AFTER SCHOOL 3-4:15pm Practices Nov-Feb/March 2025

BEFORE SCHOOL 7:45am Practices

Gr 5 Girls Monday 3-4:15pm and Thursday noon Gr 6 Girls Friday 3-4:15pm and Tues 7:45am/Wed noon Gr 6/7 Thursdays 3-4:15pm and T/Th noon Gr 7 Girls Wed 2:30-4:15pm and Mon noon/Th 7:45am Boys

5 Boys Tuesday and Thursday 3-4:15pm

OR Series of off-site activities (Specify program): Games, tournaments, multi-school events held at various venues

Purpose or educational goal(s)

PROVIDE OPPORTUNITIES FOR STUDENTS TO SHOWCASE TEAMWORK AND/OR ATHLETIC SKILL WITH THE POSSIBILITY OF RECOGNITION FOR EXCELLENT PERFORMANCES IN ATHLETICS.

PRACTICES, GAMES AND TOURNAMENTS

Total Number of Supervisors Planned Mr. Klaponski, Mrs. Hosein, Mr. Waweru, Mr. Figueroa,LEAD TEACHER AND STAFF Mrs. Miller and Ms. Manuel

The board will make every reasonable effort to ensure or ascertain that:

a.The staff, volunteers and/or service providers involved are suitably trained and qualified.
b.The students are adequately supervised over the program/activity.
c.The location(s) used are appropriate for the activity(ies) and group.
d.Equipment used has been inspected and deemed appropriate and safe.
e.A Safety Plan is in place to identify and manage known potential risks.
f.An Emergency Plan is in place to deal with an injury or illness to any of the students.

Potential known risks include the following

INJURIES INVOLVED WITH FALLING FROM STANDING OR SITTING POSITIONS, INJURIES INVOLVED WITH TRANSPORTATION IN VEHICLES TO AND FROM EVENTS, INJURIES INVOLVED WITH THE ACTIVITY OF BASKETBALL.

Consent and Acknowledgement of Risk

1. I acknowledge my right to obtain as much information as I require about this program or activity(ies) and associated risks and hazards, including information beyond that provided to me by the school or board.

2.I freely and voluntarily assume the risks/hazards inherent in the program/activity(ies) and understand and acknowledge that my child/ward may suffer personal and potentially serious injury arising from his/her participation.

3.My child/ward has been informed that he/she is to abide by the rules and regulations, including directions and instructions from the school's and/or service provider's administrators, instructors, and supervisors over all phases of the program/activity(ies

4.In the event my child/ward fails to abide by these rules and regulations, disciplinary action may require his/her exclusion from further participation, or that I be contacted to have him/her picked up, unless I have specified other transport arrangements. I assume all related costs.

5.I acknowledge that it is my responsibility to advise the Lead Teacher of any medical and/or health concerns of my child/ward that may affect his/her participation in the stated program or activity(ies

6.I consent that the board, through its employees, agents and officers, may secure such emergency medical advice and services as they deem necessary for my child/ward's health and safety, and that I shall be financially responsible for any costs related to such advice and services.

7. Based on my understanding, acknowledgement, and consents as described herein,

I grant permission for (Catholic Independent Schools of Vancouver Archdiocese) to use, without payment of any fee or charge and without limitation on time or frequency, for non-profit education and/or promotional purposes only, any photographs, video footage, audiotape or digital images of my child/ward.*

YesNo

Name of Student*

Grade*

Date of Birth yyyymmdd*

Date

has my permission to participate

Date yyyymmdd*

Date

ParentGuardian Name*

Emergency Contact Numbers*

Signature*

Home*

Day Phone No.

Email*

example@example.com

Personal information contained on this form is collected under the authority of the School Act for the purpose of participating in school trips. If you have any questions about this form, please contact your school administrator.