WALKING FIELD TRIP FORM

If you have any questions contact Ms. Oliver at (204) xxx-xxxx ext. xxx or

oliverm@myumanitoba.ca

The English Additional Language Club promotes students learning English by getting actively

involved with the school and community, and as such, they will be walking and familiarizing

themselves with the surrounding school community with their peers. Students and the staff will

create the times in advance when we will go walking, and as such you will be notified in advance

of any walking trips your child may take.

• I, (student’s name) ________________________________________________, hereby agree

that I will listen to Ms. Oliver and the other English Additional Language staff while I am on

walking fieldtrips and will not endanger myself, my fellow club members, or the English

Additional Language staff members by leaving without permission, recklessly going into

oncoming traffic or straying away from the rest of the club. I hereby sign and understand that if I

break my agreement I lose the right to come on these trips and my membership will be under

consideration and could be revoked.

• I, (student’s name) ________________________________________________, hereby agree

that I will not confront or talk to strangers and risk the safety of myself, my fellow club

members, and the English Additional Language staff members. I hereby sign and understand that

if I break my agreement I lose the right to come on these trips and my membership will be under

consideration and could be revoked.

• I, (student’s name) ________________________________________________, hereby agree

that I will not contact people outside of the club to coming with us on our walking field trips, and

I understand that contacting people outside of the club can risk my safety, my fellow club
member’s safety, and the English Additional Language staff member’s safety. I hereby stand and

understand that if I break my agreement I lose the right to come on these trips and my

membership will be under consideration and could be revoked.

• I, (parent’s name) ________________________________________________, hereby have

read the terms my child has signed above and understand the risk and safety that my child has

agreed to and understand that if they break their agreement that their actions can result in the

harm of themselves, their fellow club members, and the staff. I understand that my child’s

membership in the English Additional Language Club will be under consideration and revoked if

necessary.

• I, (parent’s name) ________________________________________________, hereby give my

permission for my child to go walking around the community with Ms. Oliver, and the other staff

and students from the English Additional Language Club.

• Emergency Contact Information

Contact’s Name: _________________________________________________

Relation: _______________________________________________________

Phone Number: __________________________________________________

Student Name (Print): ___________________________________________________________

Student Signature: ______________________________________________________________

Parent or Guardian Signature: _____________________________________________________

Date: _________________________