Field Study Consent and Liability Waiver CENTRAL PARK FIELD STUDY, October 13, 2016
This is a consent form for allowing students to conduct field study within the Lower Mainland for course work in science class. OUR DESTINATION IS CENTRAL PARK BURNABY
DESCRIPTION OF FIELD STUDY: Meet at Patterson Sky-train Station with your pre-assigned group, Expo Line at Ground level for attendance at 1: 45pm. PLEASE SHOW THIS CONSENT FORM TO YOUR THIRD BLOCK TEACHER SO YOU MAY HAVE AN EARLY DISMISSAL FROM CLASS. We will take attendance at street level and then proceed into the path shown in red. Further, we will walk adjacent to the pitch and putt and go into a few of the trails. All students are expected to remain with their pre-assigned group and group leader. We will survey the vegetation in a Pacific West Coast Rainforest and familiarize ourselves with the trees, bushes and groundcover. At 3pm, we will dismiss the class. Students will be dismissed ON SITE AT CENTRAL PARK. This field study will be conducted rain or shine. Be prepared for the weather. The route below shows our itinerary
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
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
I agree that during this field study, my child will travel to and from the destination above. Furthermore, the school responsibilities are as follows:
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
I understand that there is an element of risk in this field study
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. I understand that this activity is suitable for my child.
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
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 you to write your signature. Sign the form when the student presents it to you
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Additional Terms