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Beaty Museum Field Study Parental Consent Form:
This is a consent form for allowing students to conduct field study within the Lower Mainland for course work in science class
FIELD STUDY: BEATY MUSEUM, UBC
ON A DAY 1 DATE IN JANUARY, the Biology Class will be visiting the Beaty Biodiversity Museum located at UBC. Website is here: http://beatymuseum.ubc.ca/ and its address is here: 2212 Main Mall, Vancouver, BC V6T 1Z4. Students are expected to arrive at the museum for attendance and they will be dismissed from the museum.
ITINERARY : Check the choice that you belong to according to your block. Your itinerary depends upon your block *
First Name of Student *
Your answer
Last Name of Student *
Your answer
Student number *
Your answer
science block *
Your answer
email of student *
Your answer
Cell phone number of student *
Your answer
As a student participant, I agree to email this consent form to the teacher whose blocks are affected by this field study. I understand that if my teacher is not notified, MY PERMISSION FOR THIS FIELD STUDY MAY BE AFFECTED by the teacher
THE COST of this field study is estimated to be $8 for a one time visit and I'm investigating how to get a membership for a higher cost. The membership gives you one year access
THE FOLLOWING SECTION OF THE ONLINE FORM IS TO BE COMPLETED BY THE PARENT or guardian . I certify that I am the parent or legal guardian of (Student's Full Name) *
Your answer
Parent/guardian First Name is *
Your answer
Parent/guardian Last Name is *
Your answer
Students are going to travel to and from the destination above
As a parent or guardian, I understand that students are responsible for their own transportation to the destination and this transport may be unsupervised. I agree to this *
As, parent/guardian, I give permission for (name of student) *
Your answer
to participate in the field studies described above. I understand my child may be exposed to a risk of injury due to accident while participating in this activity
Should it become necessary for my child to have medical care, I hereby give the teacher permission to use his/her best judgment in obtaining the best of such service for my child. I understand that any cost will be my responsibility. I also understand that in the event of illness or accident, I will be notified as soon as possible via the emergency contact information provided by me *
Medical/Emergency information
OPTIONAL :My child's BC health number is
Your answer
emergency contact information: name of person and telephone *
Your answer
I certify that I am the Parent/Guardian of the student named in this form and that I have completed this consent form *
My phone number is *
Your answer
My email is *
Your answer
The school will provide a paper form for the parent to write a signature. I will sign the form when the student presents it to me and the form will be returned to the teacher. *
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