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SECTION I: INSTRUCTIONAL PROGRAM

Page 1 of 3

File IEE-E3

GRADE 11 & 12 PHYS. ED/HEALTH ED. OUT-OF-SCHOOL AGREEMENT

PARENT DECLARATION AND CONSENT & STUDENT DECLARATION FORM FOR NEW ACTIVITIES (FOR STUDENTS UNDER 18 YEARS OF AGE)

 

 

NAME OF SCHOOL: __________________________________

 

A student who is under the age of 18 must have this form completed 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 when activity choices have been revised. Please return the completed form to the teacher of this course.

Parent Declaration:

 

bulletI understand that the new physical activities my child has chosen for the OUT-of-class component of this course have been accepted by the PE/HE Teacher as indicated on my child’s revised Personal Physical Activity Plan (attached).
bulletI have reviewed the recommended safety guidelines for the new physical activities chosen by my child and have discussed them with my child.
bulletI 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.
bulletI am aware that school staff will not inspect the facilities or equipment to be used by my child for the non-school-based physical activities he/she has 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 he/she has chosen for this course. This may include investigating for evidence of general liability coverage.

 

 

 

Page 2 of 3

File IEE-E3

bulletI am aware that the school staff will not be present or in any way involved in supervising my child while he/she participates in the non-school-based physical activities he/she has 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 appropriate to his/her chosen activities.
bulletI will encourage my child to abide by the recommended safety guidelines that are appropriate for the new physical activities he/she has chosen for the OUT-of-class component of this course, and any other more stringent safety standards imposed by his/her instructors, coaches, or program leaders while he/she is participating in his/her chosen physical activities for the OUT-of-class component of this course. This is to ensure, to the extent reasonably possible, that no one is injured and no property is damaged or lost as a result of my child’s participation in the OUT-of-class component of this course.
bulletI understand that I will be responsible for paying for any and all fees that may result from my child’s participation in the new physical activities he/she has chosen for the OUT-of-class component of this course.

Parent Consent:

Having considered my child’s mental and physical condition, and the risks and suitability to him/her of the new physical activities he/she has chosen for the OUT-of-class component of this course, I consent to my child participating in his/her chosen physical activities.

I have read, understand, and agree with the above statements.

 

___________________________________________________ _________________

Parent Signature (if student is under 18 years of age)

Date

 

Page 3 of 3

File IEE-E3

Student Declaration:

bulletI am aware of the recommended safety guidelines for the physical activities that I have chosen for the OUT-of-class component of this course.
bulletWhile participating in these activities, 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.
bulletI 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.
bulletI understand that if I want to choose other physical activities that are not part of the attached revised Personal Physical Activity Plan for inclusion in the OUT-of-class component of this course, prior to participation I must
bullethave these new physical activities accepted by the PE/HE teacher
bulletobtain the recommended safety guidelines for these new physical activities, and
bulletreceive my parent’s consent to participate in these new physical activities

I have read, understand, and agree with the above statements:

 

________________________________

___________________________

________

Student’s Legal Last Name

First Name

Middle Initial

___________________________________________________

________________

Student Signature (if student is under 18 years of age)                            Date

 

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