Open IYLS Permission Form

Consent for Participation in the
2015 International Youth Leadership Summit
School Address, Calgary, AB T2X X4X
t | 403-XXX-XXXX f | 403-XXX-XXXX | [email protected]
Please note, students MUST bring signed consent forms to the IYLS in
order to receive their registration package and participate in the day’s
events. Without signed forms they will not be allowed entry.
I, _____________________________, allow my son/daughter
___________________ to participate in the 2015 International Youth
Leadership Summit (IYLS) on Saturday, May 2nd, 2015 at the CBE Education
Centre, 1221 8th Street SW, Calgary, T2R 0L4.
I understand that my son/daughter’s involvement in this summit is completely
voluntary and also understand, and freely accept, that there are some
anticipated risks in this activity that include but are not limited to:
Activity
Hazard(s)/Risk(s)
Summit
Slips, Trips and Falls
Fire and Evacuation
Unfamiliar Environment
Students Getting Lost and/or separated from the group
Pre-Existing Medical Conditions
Contact with Other Participants
Lunch
Choking and Allergies
Terms & Conditions:
§ I am satisfied that I have been informed of my right to obtain as much
information about this program, or activity as I feel necessary, including
information beyond that provided to me by the school or Board to the extent
that I require and am not, in any way, relying solely upon information
provided by the Calgary Board of Education respecting the nature and
extent of the risks and hazards associated with the program or activity.
§ I freely and voluntarily assume the risks and hazards inherent in the nature
of the program or activity and understand and acknowledge that my child,
as a participant, may suffer personal and potentially serious injury due to an
unforeseeable or fortuitous event.
§ My child has been informed that he/she is to abide by the rules and
regulations including directions and instructions from the school’s teachers,
instructors, and supervisors as imposed on students while participating in
the program or activities. This shall include his/her participation in all of the
sessions and meet all prerequisites prior to his/her participation in the
activity or program.
§ In the event that my child fails to abide by the rules and regulations
imposed on the student while participating in the program or activities,
disciplinary action may either require that he/she not participate in the
program or activity, or that I will be contacted to have him/her picked up,
unless I have permitted my child to pursue alternate means of
transportation as identified herein.
§ I acknowledge that it is my responsibility to advise the Board of any medical
§
or health concerns of my child which may affect his/her participation in the
stated program or activity.
I consent that the Board, through its employees, agents, and officers at the
school may secure such medical advice and services as those individuals,
in their sole discretion, may deem necessary for my child’s health and
safety, and that I shall be financially responsible for such advice and
services.
I understand that comments/feedback from participants in this event will be
coded in such a way that a student’s name or identifying information will not be
attached to the information. All data collected will be reported and used in
aggregate form.
I understand that there will be video recording and photographs taken at this
event. These may be posted in a variety of locations to share this experience
with administrators, teachers, the Board of Trustees, and fellow conference
goers. The media captured may appear on our jurisdiction’s website or on our
Twitter feed (iyls2015). I understand that by attending this event my
son’s/daughter’s image may appear in the video/photographs. I also
understand that my child may be asked to comment on camera, but is free to
decline.
I freely accept the risks and allow my child to participate in the IYLS.
________________________
Student Name (printed)
_________________________
Parent/Guardian Signature
________________
Date
Thank you for allowing your child to participate in this exciting event! Although
there are no fees for participating in the summit we are happily accepting nonperishable food donations and toiletry items on behalf of the Inter-Faith Food
Bank and The Drop-In Centre.
Sincerely,
Aubrey Fletcher
System Assistant Principal, Global Learning
t | 403-817-7721
[email protected]
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