Bessie Nichols

Field Trip Consent Form

Student Name:
To Parent(s) or Guardian(s)
Please carefully read the contents of this consent form before signing it. Clarify any concerns with the teacher-leader or
principal before signing it. If this consent form is not signed and returned to the school by December 14, 2022, your
child WILL NOT BE ALLOWED TO ATTEND.

Description of the Trip

Field Trip Name: Strathcona Wilderness Centre - EOE 8 Field Trip Date: December 19, 2022

Additional Dates:
None
Purpose or Educational goal:
The purpose of this field trip is to cover objectives of the environmental outdoor education curriculum which are:
Students will demonstrate awareness and appreciation of living things and understanding of basic ecological processes,
students will develop knowledge and skills by investigating the effects of human lifestyles on environments and students
will develop lifestyle strategies that foster contact with the natural world, encourage responsibility for local and global
environments and encourage living in harmony with others.
Proposed Itinerary:
11:30 am - Students will be leaving the school to board the bus.
12:15 pm - 12:40 pm Lunch - Students will need to bring a bagged lunch
12:45 pm - 2:24 pm - Programming with Strathcona Wilderness Centre (cross country skiing) (Address: 52535 Range
Road 212, Ardrossan, AB) (Phone Number: 780 - 922 3939)
2:30 pm - Meet bus
3:15 pm - 3:30 pm Return to school (189 Hemmingway Road, Edmonton, AB.)

Method of transportation to be used: Bus

Cost to the student:
Breakdown of cost
Transportation - Bus $15.00
Admission $18.00
Total Cost $33.00

Number of participants - students and supervisors: 26

Detailed description of all activities:
We will be leaving the school at 11:30 and taking the bus to the Strathcona Wilderness Centre. Programming with the
City of Parkland instructors will begin at 12:45pm and last until 2:30 pm. We will be participating in their Outdoor Skills
program that focuses on survival in the Outdoors.

In this program students will learn the "FUNdamentals" of classical cross country skiing. Through a combination of
motion on skis, active games and skill development students will learn the basics of diagonal stride and uphill and
downhill techniques. Students will use these skills on a short tour around the trails. Concepts of safety and trail etiquette
will be discussed.

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Student Name:

Cooperative Games: If time permits students will participate in various cooperative games. This activity will be
supervised by Bessie Nichols staff members and parent volunteers.
Detailed description of contingency plan:
In the event that the field trip is cancelled or for any reason a student not be able to attend, regular scheduled class will
occur.

Detailed description of any unusual or significant hazards:

There is risk of bodily injury involved when skiing. Significant hazards could include falling. In order to reduce risks of
injury, students are required to wear appropriate clothing. Safety precautions will be made known to students and they
must participate responsibility by following all the rules and procedures communicated to them and within their
capabilities.

Description of Supervision
Name of teacher-leader in charge: Mrs. Crystal Grombach
To ensure complete safety of our students, the following requirements for the volunteers are in effect:
- All volunteers must submit a Division Volunteer Registration form.
- An application for a police records check must be submitted by the volunteer coaches, volunteer
chaperones of overnight fieldtrips; and volunteer drivers transporting students.

Supervisory arrangements (on bus, at ski hill, etc.):

Mrs. Grombach will attend the field trip, be on the bus and provide supervision throughout the trip. She is trained in
standard first aid and CPR and student emergency contact information will also be carried. Strathcona Wilderness
interpreters are trained in first aid. A cell phone will be carried at all times and first aid kits will be on hand.

Safety precautions (e.g. – wearing helmet on skating rink, supervisors with first aid training, for alpine
skiing/snowboarding: mandatory lessons or CSIA certification):
Environmental Hazards: Insects - Students will wear appropriate clothing and will take shelter during extreme weather
conditions.

Emergency procedures to be followed in the event of injury, illness, or unusual circumstances:

- In the event of an injury or illness, a typical emergency response to be followed by supervisory staff may include
the following:
- assessment of the situation and provision of first aid as necessary
- decision to involve emergency response teams (paramedics, etc.)
- contact with parent/guardian/emergency contact (when possible)
- decision to proceed with emergency assistance and necessary medical treatment
- Unusual circumstances may include plans to respond to any students whose unacceptable behaviour interferes with
the safe, respectful or orderly operation of the field trip.
- Parents, school administration, and Division Support Services will be notified of any emergencies by phone.

Other Considerations:
For international trips: Per the Government of Canada’s Travel and Tourism website, the current travel risk level for
this field trip is: Exercise normal security precautions.
Please remember to dress for the weather and bring a bagged lunch

Thank you for considering your child's participation in this field trip.
Principal: Teacher:
Jeremy Brooks Mrs. Crystal Grombach

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Student Name:

Consent and Authorization:

Important: Parents(s)/Guardian(s). The following sections contain important information. Please read them
carefully and ensure that you understand them completely.

Changes to Itinerary and Associated Costs

I understand that the field trip will follow the description of the field trip set out above as closely as possible. I also
understand that contingencies can arise that necessitate sudden changes to activities and destinations.
I agree that the supervisors of the field trip have full authority to make decisions of this nature without
obtaining my further consent.
If such changes involve extra cost, I agree to repay the school division for those costs associated with my
child.

Cancellation of Field Trip

I understand that the Superintendent of Schools has full authority to cancel or modify any field trip without notice for
any reason the Superintendent deems appropriate.
I also understand that such cancellation may mean that some or all of the money I have paid for the field trip might not
be refundable.
I agree that the Superintendent has such authority and that the school division will not reimburse me for any
money I may have lost as a result of such cancellation.

Discipline
I understand that my child must obey the rules established by the school and the field trip supervisors.
I agree that if my child severely breaches the rules he or she might be sent home.
I agree that if my child is sent home under such circumstances, I will be responsible for all associated costs
incurred, including the cost of special travel arrangements.

Illness and Injury

I understand that illness and injuries sometimes occur on field trips.
I agree that if illness or injury necessitates the expenditure of money for special travel arrangements or any
other reason deemed necessary by the field trip supervisors, I will be responsible for all of those costs.
I authorize any of the adult supervisors on the field trip to consent to any medical attention my child may
require.

Student Accident Insurance

Edmonton Public Schools purchases Blanket Student Accident Insurance for the benefit of students and parents.
However, that insurance is not applicable to international field trips. Parents are strongly encouraged to review
coverage under the Blanket Student Accident policy.

Families may purchase additional insurance called "Voluntary Student Accident Insurance by StudyInsured". Parents
are encouraged to review this additional insurance coverage.

I agree that I will purchase Voluntary Student Accident for my child if I wish to have such insurance.

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International Travel
It is important to note, that neither the Blanket Student Accident coverage nor the Voluntary Student Accident
insurance cover cancellation insurance for international travel. However, the Division has purchased additional
insurance that has limited coverage should the Superintendent cancel an international trip. I understand that in the
event that the Superintendent of Schools cancels a field trip, such cancellation may mean that some or all of the
money I have paid for the field trip may not be refundable.

I understand there are increased risks involved with international travel and the precautions that need to be
undertaken.

Edmonton Public Schools has purchased Outbound Student Plan travel insurance for all students. The plan provides
only limited coverage including: emergency hospital and medical benefits, specific loss indemnity benefits, baggage
benefits, trip cancellation and trip interruption benefits. For coverage specifications, families are strongly encouraged to
review the Policy information.

Division Outbound Student Plan coverage is considered secondary to family/student-purchased travel insurance. This
means that your own purchased coverage would pay costs first and the Division coverage would be the "second"
payer for qualifying claims.

I agree that I will purchase separate Student Travel insurance for my child if I wish to have additional
insurance coverage.

I understand that if I or the school cancels participation in the field trip, all fees will be forfeited and no refunds will be
provided.

Proof of Measles Vaccination/Immunity

This trip itinerary does not include travel to regions deemed by the Government of Canada to be measles endemic, or
regions where measles outbreaks have been declared by local authorities.

I understand that if a measles outbreak is declared prior to the trip's departure date, I may be required to provide the
teacher-leader with proof of measles vaccination or immunity.

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 Bessie Nichols
Field Trip Consent Form

Student Name:

Field Trip Name: Strathcona Wilderness Centre - EOE 8 Field Trip Date: December 19, 2022

Cost to the student: $33.00

Consent
I have read and understood all of the information in this package.
I have obtained any additional information I feel I need to satisfy myself that I want my child to
participate in the field trip.
I consent to the participation of my child named below in the field trip.
I understand that photos or videos of students attending or participating in a field trip that is open to the general
public may be taken by participants, others, or the media, and that Edmonton Public Schools cannot control or
prevent the further distribution of these images.
I also consent to my child's participation in all activities associated with the field trip except as I have specified
below:

Student's Name: (please print)

Parent/Guardian Name: (please print)

Parent/Guardian Comments:

Parent/Guardian Signature:

Date:

Other information:
Student’s Medical Information (please advise us of any known medical condition(s), allergies, dietary restrictions, fears,
etc.):

I am able to volunteer for this field trip to Strathcona Wilderness Centre: _____ yes _____ no

Paid online _____ yes _____ no

For Office Use Only: This signed consent form must be retained for 3 years, according to the School Retention Schedule.

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