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, there is a $10 athletic fee for each athlete per sport to a maximum of $15/student/season.  This is to help the school cover the cost of athletic fees of organizations that host events. The $10 fee will come out of your account via EFT on (October 15th, 2025) if you have signed a permission form.

If this permission is not signed and returned to the school your child WILL NOT BE ALLOWED TO ATTEND.

Date Form Must be Returned by: September 8, 2025

Program/Activity Information 

Destination: CLOVERDALE CATHOLIC SCHOOL AND CISVA SCHOOL

BUILDINGS, GYMS, FIELDS, and PARISH BUILDINGS.

 

Destination/activity 

PRACTICES AT CLOVERDALE CATHOLIC SCHOOL AND CISVA SCHOOL BUILDINGS, GYMS, FIELDS, PARISH CENTERS, EVENTS HELD AT CITY BUILDINGS

Grade 5 GIRLS Volleyball 
Tuesdays (8-8:45am);  
Sept 16, 23, Oct 7, 14, 21, 28, Nov 4
Wednesdays (2:45-4:00pm); 
Sept 17, 24, Oct 1, 8, 15, 22, 29, Nov 5

Grade 6 GIRLS Volleyball 
Fridays (8-8:45am);  
Sept 18, 25, Oct 2, 9, 16, 30, Nov 6
Thursdays (3-4:15pm); 
Sept 19, 26, Oct 3, 10, 17, 24, 31

Grades 5,6,7 BOYS Soccer 
Mondays (noon) AND Thursdays (3-4:15pm); 
Sept 11, 18, 25, Oct 2, 9, 16, 23, 30, Nov 3

Grade 7 GIRLS Volleyball 
Tuesdays (noon and 3-4:15pm)
Sept 16, 23, Oct 7, 14, 21, 28, Nov 4

Grade 2-7 Cross Country Running Practices
Tuesdays (3-3:45) Sept 9, 16, 23 and Monday and Thursdays (8:15am) Sept 8, 11, 15, 22, 25

 

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     MR. HEAH   MRS.MILLER
MRS. SHEARDOWN  MS. MANUEL   MR. GROSJEAN
MRS. SCHNEIDER   MRS. PISTRIN MR. PISTRIN  
MS. PARAISO   MS. GARISTO

Cost to the student: $10 athletic fee for each athlete per sport to a maximum of $15/ student/season

Other Considerations: Parents are responsible for getting their children to games and tournaments- the school will not organize rides for the students. 

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 RUNNING, VOLLEYBALL and SOCCER

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,

has my permission to participate

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.