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Current School
Bus Route Information and School Closures















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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)
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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:
 | I 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). |
 | I have reviewed the recommended safety guidelines for the new physical
activities chosen by my child and have discussed them with my child. |
 | 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 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
 | I 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. |
 | I 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. |
 | I 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.
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___________________________________________________
_________________ |
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Parent Signature (if student is under 18 years
of age) |
Date
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Page 3 of 3
File IEE-E3
Student Declaration:
 | 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 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. |
 | 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 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 |
 | have these new physical activities accepted by the PE/HE teacher |
 | obtain the recommended safety guidelines for these new physical
activities, and |
 | receive my parent’s consent to participate in these new physical
activities |
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 under 18 years
of
age)
Date |
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