Student Travel / Emergency Medical Consent Form (Page 2 of 2) in pdf

APPENDIX D

School Activity/ Trip Permission Form

(Completed for each school activity/Fieldtrip)

School:

_______________________________________

Type/Date of School Activity/Trip: _______________________________________

Student Name:

_______________________________________

Section A:

I hereby agree to allow my child ________________________to participate in the school

activity/trip indicated above. I acknowledge that my child is healthy and well enough to

travel/participate in the above noted activity.

_________________________

____________________

Signature of Parent/Guardian

Date

Section B: (To be completed when private vehicles are used)

I hereby give permission for my child ______________________ to travel to the above

noted activity by parents in private vehicles as organized through the school. I am aware

that all drivers and vehicles used follow the regulations in Policy IJOAB (A) (Student

Travel).

_________________________

____________________

Signature of Parent/Guardian

Date

Policy IJOAB(A) Point 17

When schools involve adults (teachers, parents, volunteers, etc.) to provide transportation for students to

school events using private vehicles, the principal must ensure that Appendix A (Private Vehicle

Approval Form) has been completed and signed. Appendix B (Private Vehicle Travel Record Form) is

provided to document school travel by private vehicles. Appendix A requires the driver to sign

confirming each of the following:



 A valid driver’s license

 Current insurance that includes a minimum of $1,000,000 Public Liability (Note: $1,000,000

public liability required but $2,000,000 recommended) Accident Benefits

 A licensed vehicle in safe running order that is equipped with snow tires for the winter driving

season. (November 1 – April 30)

 The adult has contacted his/her insurance company to confirm that transportation of students to

such activities does not violate his/her insurance policy.

 The occupant limit of the vehicle does not exceed the number of seatbelts.

 The adult( if not an employee) is registered as an official volunteer with the school following the

procedures outlined in the Volunteers Policy (Policy IJOC) and, given the status of a High Risk

Volunteer, has submitted an acceptable Certificate of Conduct from the RNC/RCMP to the

Principal. (Including a Vulnerable Sector Check)

Student Travel / Emergency Medical Consent Form Page 2