Please complete the form below. 

A typed name acts digital signature of consent.

École St. Anne School is arranging walking visits throughout the community of Whitecourt for Kindergarten to Grade 3 students on various dates throughout the year (September 2026-June 2027).

Field Trip Information

Teacher: All teachers Class: All classes

Date: Various dates throughout the year (weather permitting)

Supervisors: Classroom teachers, facilitators & EAs

Destination: Community Walks

Departure: Class Specific Return: Class Specific

Transportation: Walking

Description of Trip:  Students will have the opportunity to walk throughout the community of Whitecourt with their classes.

THIS FORM MUST BE READ AND SIGNED BY A PARENT OR GUARDIAN OF A PARTICIPATING STUDENT.

Elements of Risk:

Education activities such as field trips involve certain elements of risk. Injuries may occur while participating in these activities. The following list includes but is not limited to, examples of the types of injury which may result from participating in walking throughout the community of Whitecourt on various dates throughout September 2026-June 2027.

1. Slips, Sprain, Strains, fractures

2. Concussions

3. Water Injuries/hazards (including drowning)

4. Pedestrian/motor vehicle accidents

The risk of sustaining these types of injuries result from the nature of the activity and can occur without fault of either the student, or the school board, its employees/agents, or the facility where the activity is taking place. By choosing to take part in this activity, you are accepting the risk that you/your child may be injured.

The chance of an injury occurring can be reduced by carefully following instructions at all times while engaging in the activity.

If you choose to participate in walking throughout the community of Whitecourt on various dates throughout September 2026-June 2027, you must understand that you bear the responsibility for any injury that may occur.

Release of Liability and Agreement

In consideration of allowing my child to participate in events, activities or travel, I acknowledge that I am aware of the possible RISKS, DANGERS, and HAZARDS as outlined above and I agree on behalf of my child;

To ASSUME and ACCEPT all risks arising out of, associated with or related to my child’s participation.

To WAIVE and RELEASE Living Waters Catholic Separate School Division and École St. Anne School from any and all liability for any loss, damage, injury or expense that I or my child may suffer as a result of my child’s participation.

To INDEMNIFY and HOLD HARMLESS Living Waters Catholic Separate School Division and École St. Anne School from any and all claims, demands, actions and costs for loss, injury, damage or expenses whatsoever that might arise out of my child’s participation.

Living Waters Catholic Separate School Division does not provide accidental death, disability or dismemberment, or medical expense insurance on behalf of the students participating in this activity.

Contact and medical information is on file.  If any changes have occurred, please contact the office to update.

Acknowledgment

WE HAVE READ THE ABOVE, WE UNDERSTAND THAT PARTICIPATING IN THE ACTIVITY DESCRIBED ABOVE, WE ARE ASSUMING THE RISKS ASSOCIATED WITH DOING SO.

I, the undersigned parent or guardian of the participant, hereby authorize and give consent to the Participant’s involvement in the field trip activities including any use of private or public or divisional transport to travel to and from activities or to the nearest medical or hospital facility in even that emergency or other medical treatment not available at the site is deemed necessary.  I hereby give consent to and authorize such emergency or other medical treatment of the participant as may be deemed advisable in the event of accident, injury or illness during the field trip, sports event or other activities.

I understand that this is a legal agreement that is binding upon myself and my heirs, executors, administrators, successors and assigns.  I have read and understand the terms of this agreement and I acknowledge that by signing this agreement voluntarily, I am agreeing to abide by its terms and I am waiving certain legal rights that my child or I may have.

I also declare that my child is fit to participate in the activity as outlined above.

Protection of Privacy – Personal information provided is collected in accordance with section 4(c) of the Protection of Privacy Act (POPA) and protected in accordance with section 10 and used and disclosed in accordance with sections 12 and 13 of the Act. It will be used for the purpose of educational programming and learning support. Information collected may be transmitted to and stored on servers outside of Living Waters Catholic Schools servers, Alberta, and Canada. Living Waters Catholic Schools cannot guarantee protection against disclosures as a consequence of foreign laws. Living Waters Catholic Schools may use automated systems in processing this collection of personal information. Should you require further information about collection, use and disclosure of this collection of personal information, please contact the Living Waters Privacy Officer via email: [email protected] or tel: 780-778-5666.