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Current School
Bus Route Information and School Closures
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SECTION
I: INSTRUCTIONAL PROGRAM |
Page 1 of 2
File IEE-E4
GRADE 11 & 12 PHYS. ED/HEALTH ED. OUT-OF-SCHOOL
AGREEMENT
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PARENT DECLARATION FORM FOR NEW ACTIVITIES (FOR
STUDENTS 18 YEARS OF AGE AND OLDER) |
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 when activity choices have been revised. Please
return the completed form to the teacher of this course.
Student Declaration
 | I understand that the new 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 revised Personal Physical Activity Plan (attached). |
| I have reviewed the recommended safety guidelines for the new 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), I may consider
myself sufficiently trained and competent to adapt the guidelines. On the
other hand, in the case of organized programs, instructors/coaches/program
leaders of OUT-of-class physical activities may impose more stringent safety
standards. |
| 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. |
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9. For
most activities, the recommended safety guidelines may be obtained from the
teacher of this course or viewed online at the following website: (division or
school URL where guidelines may be found).
10. Non-school–based
activities are home-, community-, or independently based activities that are
not directly organized by the school or school division, such as community
sports, classes and clubs, and exercising at home.
Page 2 of 2
File IEE-E4
| 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 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. |
| 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 the new physical activities I have chosen
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 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, and the risks and
suitability to me of the new 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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