SCOTTCREEKMIDDLE SCHOOL

1240 Lansdowne Drive, Coquitlam, BC V3E 3E7

Phone:604-945-0156

PARENT/GUARDIAN OPTIONAL FIELD TRIP CONSENT FORM

April 14th, 2014

To Parents and Guardians:Division: 17, 18, 19

The purpose of this letter is to inform you about a proposed optional field trip involving your child, and to seek your support and written permission for your child to participate.

Our optional planned field trip is to Terry Fox Theatre. Attendance on the field trip isoptional; therefore if you do not wish your child to participate in this activity, alternate learning experiences will be provided at the school. The cost of the field trip reflects your child’s expenses only. No student will be denied access to a field trip or activity due to an inability to pay.

Mrs. Kyllonen, Ms. Sahota, Ms. Lee______

Teacher’s NamePrincipal/Vice-Principal’sSignature

Date of Field Trip: Thursday, May 1, 2014

Nature of the Field Trip: Performance of Willy Wonka

Place:1260 Riverwood Gate, Port Coquitlam, BC

Departure Time: 12:15.Anticipated Return Time: 2:30 P.M.

Teacher(s)/Administrators(s)in Charge:

Other Adult Supervisors:

Your son/daughter will be traveling by:_____School Owned Bus✓ Private Vehicle

_____Rented Bus_____ Other (walking)

Cost of Optional Field Trip: $7

Please complete the consent form below and return the completed form to the sponsor teacher:

Parent/Guardian Optional Field Trip Consent Form

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Parent/Guardian Permission

While school staff will take reasonable steps to prevent injuries to students, some degree of risk is inherent in the nature of activities, and may occur without fault on the part of the student, school board, its employees or agents, or the facility where the activity is taking place. By allowing your child to participate in this activity, you are agreeing that the activity described above is suitable for your child, and that there is a risk of injury associated with the activity.

Comments (please include special concerns which school staff should be aware of surrounding your child’s participation):

______

______

My child and I understand that both the district and school’s Code of Conduct applies during the field trip. I will be responsible for any costs caused by my child’s failure to abide by the Codes of Conduct, including any costs to send my child home.

My child will participate in the field trip.

I, ______, give permission for my child ______, to participate in the optional

field trip described above. I understand that my child may be exposed to a risk of injury due to accident while

participating in this activity. Contact phone number at time of field trip: 604-945-0156.

$ 7 enclosed

My child will not participate in the field trip.

Parent Drivers Information

I am available to drive students and I would not like to stay for the performance.

I am available to drive students and I would like to stay for the performance.

______

DateParent/Guardian SignatureEmergency Contact Phone No:

O\Office\Forms\Field Trip Consent Form