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Current School
Bus Route Information and School Closures
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SECTION
I: INSTRUCTIONAL PROGRAM |
File IEE-E2
GRADE 11 & 12 PHYS. ED/HEALTH ED. OUT-OF-SCHOOL
AGREEMENT
NAME OF SCHOOL:
____________________________________
A student who is 18 years of age or older must
complete this form to obtain credit for participation in
OUT-of-class physical activities as part of the
Physical Education/Health Education (PE/HE) credit for Grades 9 to 12. Please
return the completed form to the teacher of this course.
Student Declaration
I understand that all the physical activities I have
chosen for the OUT-of-class component of this course have been accepted by the
PE/HE teacher as indicated on my Personal Physical Activity Plan (attached).
I understand that there is a risk of injury associated
with all types of physical activity. I have reviewed the recommended safety
guidelines for the physical activities I have chosen.
I understand that the recommended safety guidelines
are believed to reflect best practice and are considered minimum standards for
physical activity in an organized or formal setting. They may, however, not
apply to all situations (e.g., home-based, recreational, or modified
activities), and more stringent safety standards may be applied by
instructors/coaches/program leaders of OUT-of-class physical activities in
organized programs.
I am aware that school staff will not inspect the
facilities or equipment I will be using for the non-school–based physical
activities I have chosen for the OUT-of-class component of this
course. I am also aware that I will therefore be responsible for ensuring, to
the extent reasonably possible, that these facilities and equipment meet the
recommended safety standards for the non-school–based physical activities
I have chosen for this course. This may include investigating for evidence of
general liability coverage.
 | I am aware that the school staff will not be present or in any way
involved in supervising me while I participate in the non-school–based
physical activities I have chosen for the OUT-of-class component of this
course. I am also aware that I will therefore be responsible for ensuring,
to the extent reasonably possible, that while participating in non-school–based
physical activities I receive the appropriate level of instruction
and/or supervision for my chosen activities. This may include investigating
for evidence of general liability coverage and requirements for personnel to
undergo criminal record and child abuse registry checks. |
Page 2 of 2
File IEE-E2
| I am aware of the recommended safety guidelines for the physical
activities that I have chosen for the OUT-of-class component of this
course. |
| While participating, I will abide by the recommended safety guidelines
that are appropriate to the nature of the activity (e.g., recreation
versus competition). When applicable, I will also abide by any other
more stringent safety standards imposed by my instructors, coaches, or
program leaders. |
| I will ensure, to the extent reasonably possible, that no one is
injured and no property is damaged or lost as a result of my
participation in my chosen physical activities for the OUT-of-class
component of this course. |
| I understand that I will be responsible for any and all fees that may
result from my participation in physical activities for the OUT-of-class
component of this course. |
| I understand that if I want to choose other physical activities that
are not part of the attached Personal Physical Activity Plan for
inclusion in the OUT-of-class component of this course, I must discuss
changing my Personal Physical Activity Plan with my PE/HE teacher. |
| I understand that my teacher must accept any additional physical
activities chosen by me, and I will be required to complete a new
declaration. |
| I have considered my mental and physical condition, as well as the
risks and suitability to me of the physical activities I have chosen for
the OUT-of-class component of this course. |
I have read, understand, and agree with the
above statements:
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___________________________ |
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Student’s Legal Last Name |
First Name |
Middle Initial |
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___________________________________________________ |
________________ |
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Student Signature (if student is 18 years and
older)
Date |
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