Extra-Curricular-Activity-Form

	A	B	C
1	PRAIRIE ROSE SCHOOL DIVISION
2	RECORD OF TEACHER EXTRA-CURRICULAR STUDENT RELATED ACTIVITIES
3	“Extra-curricular activities” means student-related athletic, social, recreational and cultural activities, with the written approval of school administration occurring outside the normal School Day, but does not include activities related to academic or instructional matters or curriculum subjects outside the normal School Day, whether such occur alone or with students, parents or administrative staff, such as (without limitation) staff meetings, parent/Teacher meetings, committee work, in-service sessions, marking and setting examinations, or marking school assignments. An eligible extra-curricular activity is an activity which has received prior approval from the school principal.
4	In any School Year a Teacher shall be entitled to a paid leave of absence of one (1) day provided that they perform fifty (50) hours to a maximum of three (3) days leave for one hundred and fifty (150) hours of eligible extra-curricular duties during a School Year. A part-time Teacher shall be entitled to the equivalent time off as a full time Teacher. The date for such leave shall be agreed upon between the Teacher and the principal. A Teacher who accumulates at least twenty-five (25) hours can access a half (1/2) day up to a maximum of two (2) half (1/2) days in a School Year. See CA Article 6.04
5	Date of Activity	Description	Time Spent (in hours)
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29	Total		0
30
31	____________________________	________________________________	__________________________
32	Teacher's Name (please print)	Teacher's Signature	Date
33
34
35	________________________________		_______________________________
36	Principal's Signature		Date
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100