Administrative Procedures

Memorandum A1061
Page 1 of 22

Date of Issue November 2009

Original Date of Issue September 1, 1984,

Subject FIELD TRIPS

References Education Act and Ontario Regulation 298

Board Policy 4240, Safe and Caring School Cultures

Board Policy 4320, Fundraising
Board Policy 4430, Field Trips
Ontario Physical Education Safety Guidelines (OPHEA)
Code of Behaviour and Ontario Regulation 298, Section 23
Simcoe County District School Board Code of Conduct
OSBIE
APM A1420 – Administration of Medication and Medical Emergency
APM A2500 – Purchasing Procedures
APM A2600 – Fundraising & Financial Accountability
APM A2620 – Field/Co-Curricular Trips – Arranging and Paying for
Transportation
APM A5410 – Injuries to Students, Visitors, Parents, and Volunteers
APM A7012 – Sailing and Windsurfing
APM A7013 – Swimming
APM A7220 – Volunteers
APM A7630 – Code of Conduct
APM A7635 – Safe and Caring School Procedures

Links FORM A1061 – 1; FORM A1061 – 2; FORM A1061 – 3;

FORM A1061 - 4; FORM A1061 - 5, FORM A1061 – 6, FORM A1061-7

Contact Business Services; School Services

Contents Page

Item 1 Guidelines................................................................................................................1

Item 2 Approvals.................................................................................................................3

Item 3 Participation .............................................................................................................4

Item 4 Supervision..............................................................................................................4

Item 5 Safety.......................................................................................................................5

Item 6 Conduct ...................................................................................................................6

Item 7 Financing .................................................................................................................6

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Item 8 Consent ...................................................................................................................6

APPENDIX A Ontario Health Plan Memo......................................................................................8

APPENDIX B Canoe Tripping – Secondary Schools ....................................................................9

FORM A1061 - 1 Field Trip Plan .......................................................................................................12

FORM A1061 - 2 Overnight/Out-of-Province/International Field Trips Consent Form.....................13

FORM A1061 - 3 Request for Approval of an International Field Trip

or a Field Trip of a Duration Exceeding Three Days ............................................15

FORM A1061 – 4 Checklist for Approval for Field Trips ....................................................................16

FORM A1061 – 5 Waiver of Student Insurance Form .......................................................................17

FORM A1061 – 6 Volunteer Transportation Authorization Form .......................................................18

FORM A1061 – 7 Informed Consent/Permission Form for Educational Trips...................................19

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1. Guidelines

1.1 Simcoe County District School Board recognizes that there is significant educational
value in properly organized and well-planned student field trips. Field trips are
board-approved educational experiences which enhance the school program and
take place away from school property. These experiences should broaden the
students’ knowledge and enhance skills required within the curriculum expectations
and may expand the opportunities within a co-curricular program.

Trips arranged for students outside the school program are not the responsibility of
a school or the Board and shall be treated as community activities. Instructional
time shall not be devoted to the preparation or planning of such events. Where
groups have organized for such purposes, legal guardians shall be informed by the
principal that the trips are not sponsored by the Board and that the Board accepts
no responsibility whatsoever. They shall not be announced in the school as a
school event, or in any way appear to be under the auspices of the Board.

1.2 Principals are responsible for ensuring that:

1.2.1 Field trips enhance the curricular and co-curricular program and the benefits
to the participants outweigh the disadvantages of missing other aspects of
their school program. Field trips are extensions of the school program.
In order to allow time for curriculum follow-up, field trips should be completed
by the end of May;
1.2.2 Board Policy 4430, Educational Visits and Student Travel and related
administrative procedures are reviewed annually with staff;
1.2.3 Prior to September 30 annually, they and their staff develop a field trip plan
(FORM A1061 - 1);
1.2.4 The planning requirements outlined in the policy and herein are met before
they approve or request approval for field trips (See FORM A1061 - 4);
1.2.5 The field trips to be undertaken are appropriate for the level of maturity and
experience of the students involved;
1.2.6 Appropriate preparation through the regular classroom program and/or other
activities and follow-up activities are part of the field trip experience;
1.2.7 The adverse affect on program by the absence of their teacher(s) for non-
participating students is minimized;
1.2.8 Except for the national capital region, preference for field trip destinations is
given to locations in Ontario. Out-of-province and international locations
shall only be considered when it can be demonstrated that the objectives
cannot be met in Ontario;
1.2.9 Safety, economy and comfort are considered when selecting an appropriate
method of travel;
1.2.10 For all field trips, legal guardians are informed, in writing, of the dates,
objectives, itinerary, student involvement, staff involvement, supervision
arrangements, expectations for student conduct, financing, foreseeable risks
and special skill requirements;
1.2.11 Parents/guardians of students and adult students taking part in field trips
outside Ontario receive a copy of the memorandum attached as APPENDIX
A to make them aware of the limitations of the Ontario Health Plan and
options available to provide additional private required health coverage;
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1.2.12 Legal guardians must provide proof of health insurance or complete the
Waiver of Student Insurance Form (FORM A1061 - 5) and cancellation
insurance for field trips outside of Ontario is mandatory and can be
purchased through most travel providers;
1.2.13 Staff planning field trips consult the principal, resource staff, students, legal
guardians and bring with them copies of Student Medical/Health Data forms
and Medical Emergency Plans (see APM A1420, Administration of
Medication and Medical Emergency) as required, in order to accommodate
students with special needs; and,
1.2.14 Staff will not benefit financially, or through attainment of goods or services,
from the organization or planning of field trips (as per APM A2500
Purchasing Procedures).

2. Approvals

2.1 Principals are authorized to approve field trips within Ontario and the National
Capital Region, which have a duration of up to three days.

2.2 All national and international field trips and those within Ontario and the National
Capital Region with a duration of more than three days are subject to the final
approval of the superintendent of education in addition to the principal's approval.
Preliminary approval must be sought and given by the superintendent prior to any
sharing of information to students or parents.

2.3 Field trips to destinations outside Ontario other than the National Capital Region
(Item 2.1) are subject to the final approval of the superintendent of education in
addition to the principal's approval.

2.4 Principals shall submit requests for approval for trips described in Items 2.2 and 2.3,
to the superintendent of education on the form Request for Approval of an
International Field Trip or a Field Trip of a Duration Exceeding Three Days (FORM
A1061 - 3) at least three months prior to the commencement of the proposed trip
and prior to any planning with students, legal guardians and the school community.
The three-month period may be waived when the trip is a direct result of
participation in a competition which leads to further participation.

2.5 Field trips involving more than one school are subject to all conditions in APM
A1061. In addition:
2.5.1 The cost for replacement staff coverage for field trips involving more than
one school shall be shared in an equitable fashion by participating schools.
This distribution of cost must be explained on the Request for Approval
Form (FORM A1061 - 3);
2.5.2 Field trip request forms must be submitted to the superintendent of
education from each participating school and must clearly designate the
teacher in charge of the field trip and his/her school location;
2.5.3 A complete list of all participating students, chaperones, school locations
and phone numbers must be submitted to the principals of all participating
schools and be made available to the superintendents of education five
school days prior to departure; and,
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2.5.4 Staff must use diligence in keeping student personal information secure and
confidential.
3. Participation

3.1 Student participation in field trips is voluntary. In cases where eligible students do
not participate, the principal is responsible for ensuring that an appropriate
instructional program is provided at the school.

3.2 No eligible student will be excluded from a field trip due to extenuating financial
circumstances. In such cases, the principal shall arrange alternative financial
support.

3.3 It is an expectation that all students will be included on field trips. In keeping with
the Safe Schools, Special Education practices, and school’s progressive discipline
practices and communication, the principal shall consult with their superintendent
prior to considering exclusion of any student to a field trip. A decision to exclude a
student shall be confirmed in writing with the reasons stated after meeting with the
legal guardians and student, where appropriate. For any student excluded from a
field trip an alternate program will be provided.

4. Supervision

4.1 All field trips shall be supervised by at least one teacher employed by the Board.

4.2 The principal shall determine the level of supervision.

4.2.1. It is recommended that the supervision ratio at the elementary school level
shall be: JK/SK 1:4; Primary Division 1:8; Junior Division 1:12; Intermediate
Division 1:15 except where specified otherwise by other administrative
procedures memoranda.
4.2.2. The supervision ratio at the secondary school level should not exceed 30
students to one adult (30:1) except where specified otherwise by other
administrative procedures memoranda.

4.3 On all overnight field trips, supervisors shall be provided according to the gender
distribution of the group.

4.4 At least two lists of students and supervisors are required for every field trip:
4.4.1 one shall be kept in the school office,
4.4.2 the other shall be in the possession of the teacher in charge of the trip

4.5 Where more than one bus or vehicle is used to transport the participants:
4.5.1 the person in charge of each bus shall have a list of students assigned to the
bus or vehicle,
4.5.2 the school office shall retain a copy of each list,
4.5.3 students must travel on the bus or vehicle to which they have been assigned
5. Safety

5.1 When considering high-risk activities, the superintendent of education shall be

consulted prior to the commencement of planning.
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5.2 Principals shall ensure that all safety requirements prescribed by the Board and
outlined by the OPHEA Safety Guidelines are known and implemented when
planning high-risk activities such as skiing, snow-boarding, swimming, canoeing,
sailing, windsurfing, out-tripping, etc. OSBIE Guidelines should also be consulted.
Principals may wish to access Insurance and Risk department for information and
recommendations regarding high risk activities.

5.3 Students may not travel in 10+ seat passenger vans.

5.4 When lodged in overnight accommodations, the teacher(s) in charge shall review
with the participants, the evacuation plans and procedures to be followed in case of
fire or other emergencies.

5.5 For elementary school excursions the following information, carried out of sight of
the public by the participants, shall be available to the supervisor at all times:
5.5.1 student’s name
5.5.3 school telephone number
5.5.4 school name and location
5.5.5 person to contact in case of emergency
5.5.6 pertinent medical information

5.6 For all field trips it is the parent's/guardian's option as to whether or not the Ontario
Health Card is carried by the student. Student health numbers will not be required
for field trip participation; however, parents/guardians/students may be invited to
volunteer such information in advance of the field trip to facilitate the provision of
emergency health services if necessary. Health card numbers will be protected with
appropriate safeguards and will be securely disposed of following the completion of
the field trip.

Students requiring medical attention within Ontario, not carrying a health card, will
be billed directly through the Ministry of Health. For students requiring medical
attention outside Ontario, the Ministry of Health covers only a minimal daily fee;
extended health cover is required for such field trips.

5.7 Principals must scrutinize all waivers, contracts, and insurance policies. They may
wish to access Insurance and Risk department for clarification regarding waiver or
contract wording for insurance purposes.

5.8 Preparation for canoe tripping field trips are to meet all the requirements of the
Simcoe County District School Board Policy 4430 and APM A1061 including:
a) a thorough review of Policy 4430 and relevant APMs A7012 and A7013;
b) student training preparation and testing will have been completed as
required (Item 7 of APPENDIX B);
c) leaders are qualified and meet required criteria as per OPHEA guidelines;
d) all equipment has been checked (Item 8 of APPENDIX B);
e) restrictions outlined in APM A1061 have been discussed and addressed.
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6. Conduct

6.1 Field trips are extensions of the school program. Students are responsible to the
staff in charge and are required to conduct themselves according to the school's
Code of Behaviour and Ontario Regulation 298, Section 23 and Policy 4240 Safe
and Caring School Cultures.
6.2 When students travel by bus, the staff in charge, after consultation with the bus
driver shall outline to the participants, their responsibilities. The staff in charge shall
deal with breaches of conduct.

6.3 Where a student's conduct on a field trip is determined to be injurious to his/her

welfare and/or to the welfare or moral tone of the group, arrangements may be
made for his/her immediate and safe return to the school or student's home. In such
cases, legal guardians shall be notified of the travel arrangements and any cost
accrued for the supervisor and student is the responsibility of the legal guardian.
Staff should consider this item as one to be included in the school code of conduct.
This item should be part of the initial field trip package.

6.4 Misconduct during a field trip may result in consequences upon the student’s return.

7. Financing

7.1 Field trips of one day's duration or less, may be financed entirely or in part from the
school's basic budget at the discretion of the principal.

7.2 For voluntary trips, the incurred cost of supply teachers and Educational Assistants
will be included in the overall cost of the field trip.

7.3 Schools may undertake fundraising activities to support field trips subject to Board
Policy 4320 and APM A2600 - Fundraising & Financial Accountability.

8. Consent

8.1 For day field trips, a consent form produced by the school shall be signed by the
student or legal guardian of a student under 18 years of age, before the student is
allowed to participate in the trip. The following caution shall be included;
"While field trips are supervised by the teaching staff, they involve activities beyond
those of normal school programs. It is essential that parents/guardians counsel their
children on the necessity for extra care and co-operation."

8.2 Handwritten notes will not be accepted in place of a consent form; the original
signed document must be received by the school.

8.3 For overnight trips (see FORM A1061 – 2).

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8.4 For all field trips involving high risk activities, an Informed Consent Form (FORM
A1061 - 7) shall be signed by the student or legal guardian of a student under 18
years of age. The purpose of this form is to ensure parent/guardians are aware of
identified potential areas of risk for injury to students.

8.5 All volunteer drivers must complete a Volunteer Transportation

Authorization Form. (See FORM A1061 - 6)

8.6 For all field trips involving volunteer drivers, students or legal guardians of a student
under 18 must sign “Consent for a volunteer driver to transport”. (See FORMS
A1061 - 2 and FORM A1061 - 7).

First Issued September 1, 1984

Revised August 17, 1993; March 22, 1996; January 18, 2000, August 2009,
September 2009, October 2009, November 2009

Issued under the authority of the Director of Education

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APPENDIX A

SIMCOE COUNTY DISTRICT SCHOOL BOARD

MEMORANDUM

TO: Students and legal Guardians of students taking part in field trips outside Ontario

FROM: Superintendents of Education

SUBJECT: ONTARIO HEALTH PLAN

Students travelling outside Ontario are required to make their own arrangements for additional coverage.
Such coverage can be obtained through any combination of the following:

1. parent/guardian employer's supplemental plans;

2. private insurance plans.

3. student accident insurance

The cost of hospitalization in the U.S. can be as high as $3,000 per day.

Student accident insurance is an option made available to all Simcoe County District School Board
students through Reliable Life Insurance Co. and underwritten by Old Republic Insurance Group.
Information is available at www.insuremykids.com

This insurance package includes a special out-of-province clause which covers most of the specific
accident expense reimbursements listed in the general policy. The following exceptions should be
noted:
- it is an accident and injury insurance only; only the Super Plan Plus will pay if the emergency is
illness-related (ie: diabetes, heart disease);

- there is a toll-free number for claims assistance – 1-800-463-5437 or 1-800-334-7787 (24

hr for Super Plan Plus)

- it covers all reasonable and customary services from hospitals, doctors' offices, outpatient clinics,
etc., as long as the services are performed by a licensed medical doctor. The insurer's approval is
not required before treatment;
- it does NOT cover chiropractor, osteopath, physiotherapy services, etc. These services must be
performed in Ontario in order to be reimbursed;

- Super Plan Plus does provide emergency transportation home, if medically necessary;
- reimbursement is limited to the difference between OHIP and the actual fees charged in the area
where the service was rendered;
- the claimant MUST pay up front, submit the bill to OHIP first, and then file for eligible expense
reimbursement from Reliable Life.

Students and/or their parents/guardians should refer to their actual policy to determine their individual
coverage needs.
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APPENDIX B

CANOE TRIPPING – SECONDARY SCHOOLS

Canoe tripping is defined as travelling in groups by canoe through wilderness or semi-wilderness

areas for a period of time which includes at least one overnight camp.

1. General

1.1 Canoe-tripping activities require the prior written approval of the superintendent of
education.

1.2 Schools will submit the Simcoe County District School Board Request for Approval
of an International Field Trip or a Field Trip of a Duration Exceeding Three Days
(FORM A1061 - 3) indicating that students will have been instructed in and have
practised canoeing skills as outlined in Section 7 of APPENDIX B.

1.3 Where swimming is involved, the conditions outlined in APM A7013 - Swimming,
shall be satisfied.

2. Participation

2.1 Students currently attending Simcoe County District School Board secondary
schools are eligible to participate. Adult chaperones may be included to ensure
safety, and to assist with transportation and supervision of students.

3. Time of Year

3.1 Trips shall only be approved for the period beginning with the Victoria Day weekend
in May and ending with the Thanksgiving weekend in October.

3.2 Training for canoeing skills may occur prior to the Victoria Day weekend only on flat
water and with due diligence to related safety precautions and weather conditions.

4. White-Water Canoeing

4.1 There shall be no white-water canoeing, paddling, wading, swimming, lining, or

tracking of canoes in white water.

5. Leader Qualifications

5.1 At least two leaders are required on each canoe trip, one of whom shall be a
teacher employed by the Board.

5.2 Each leader shall be qualified in one or more of the following areas and each area
must be included in the combined qualifications of the leaders:
5.2.1 first aid as per Ontario Physical and Health Education Association (OPHEA)
guidelines.
5.2.2 supervision of swimming activities as described in APM A7013 - Swimming
5.2.3 canoeing skills as per OPHEA guidelines and as outlined in

7.1.2 of APPENDIX B; Note: Effective January 1, 2005 at least one

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APPENDIX B

supervisor must have Ontario Recreational Canoeing Association (ORCA)

Level II Canoe Tripping certification or equivalent. (Contact ORCA for
equivalencies.).
5.2.4 broad experience in canoe tripping and camping

5.3 Leaders shall be provided to reflect the gender composition of the group.

5.4 The qualifications and experience of the leaders shall be included in the submission
to the superintendent of education as per FORM A1061 - 3.

6. Supervision

6.1 The ratio shall not exceed eight students to one leader.

7. Preparation

7.1 The following shall be essential components of the preparation sessions for all
participants:
7.1.1 demonstrate the ability to swim 100 metres continuously fully clothed while
wearing a personal flotation device (PFD); tread water for three minutes
without a PFD; put on a PFD in the water; and, use the HELP position to
maintain body warmth.
7.1.2 demonstrate basic competency in performing the following canoeing skills:
power stroke, J stroke, sweep stroke, draw stroke, backwater strokes;
proper entry/exit into and from a canoe; rescues into dry and/or a swamped
canoe; canoe over canoe rescue; synchronized strokes; packing a canoe;
and portaging.
7.1.3 students must be instructed on how to handle unexpected wind and wave
conditions.
7.1.4 familiarity with basic first aid, hypothermia, suitable clothing, canoeing
equipment and repairs, camping skills and safety, environmental concerns,
and navigational skills.

8. Equipment

8.1 The leaders shall ensure that:

8.1.1 canoes are in good repair (i.e. no cracks, splinters and leaks, secured seats
and thwarts, appropriate flotation)
8.1.2 paddles are appropriately sized and in good repair
8.1.3 packs are assessed for size, waterproofing, ease of carrying and in good
repair
8.1.4 tents are assessed for design, waterproofing, bug netting, and in good repair
8.1.5 government approved personal flotation devices (PFDs) are in good repair
8.1.6. all canoes comply with Canadian Coastguard Regulations
8.1.7. stoves used for cooking are in safe operating condition
8.1.8 an appropriately stocked first aid kit per campsite is provided

8.1.9 appropriate repair kits for equipment are provided

8.1.10 an Emergency Communication Device, cell or satellite phone, as required by
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APPENDIX B

available service is provided

8.2 The leaders shall establish guidelines, amount and weight for personal equipment.

8.3 Axes are not permitted.

8.4 Participants shall wear a government approved personal flotation device (PFD) at all
times while on or around the water.
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FORM A1061 - 1

SIMCOE COUNTY DISTRICT SCHOOL BOARD

FIELD TRIP PLAN

SCHOOL Principal's Signature

SCHOOL YEAR Date

DATE PARTICIPANTS DESTINATION PURPOSE METHOD OF ESTIMATED COST

FINANCING PER PUPIL
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FORM A1061 - 2

OVERNIGHT/OUT-OF-PROVINCE/INTERNATIONAL FIELD TRIPS - CONSENT FORM

School________________________________________________________________________________

Field Trip_________________________________________ Dates________________________________

Teacher in
Charge_______________________________________________________________________

1. Student________________________________________________________________________
_
Surname First Name Middle

2. Legal Guardian

3. Address Phone

4. Business Phone

5. Emergency Phone (other than above)

6. Does the student have any medical problems that might affect participation in this field trip?

Provide details.
___________________________________________________________________

7. Does the student require medication or treatment?

If so, state medication, dosage and frequency

8. Any other comments re health and medical

_______________________________________________________________________________
_

9. Health Insurer_________________________ Policy

#_____________________________________

10. Cancellation Insurer____________________ Policy

#_____________________________________

11. Will the student be carrying his/her Ontario Health Card? Yes  No 

12. While trips are supervised by teaching staff, they involve activities beyond those of normal school
programs. It is essential that legal guardians counsel their children on the necessity for extra care
and co-operation.

13. I understand that if 's conduct is injurious to the safety or moral tone of the group, I
will be contacted and may, at the discretion of the supervising teacher, be returned
home under supervision at my expense.
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FORM A1061 - 2

14. Consent for a Volunteer Driver to Transport (if applicable)

I grant permission for ___________________ to be transported by a volunteer driver (employee,

parent or other adult) approved by the principal or designate. Volunteer drivers are over the age of
21, have a valid driver’s license, have provided a criminal record check and are adequately insured.
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FORM A1061 - 2

15. I permit  do not permit  my son/daughter to participate in this trip.

Signature of Student Signature of Legal Guardian Date

(if student is under 18)
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FORM A1061 - 3

REQUEST FOR APPROVAL OF AN INTERNATIONAL FIELD TRIP OR

A FIELD TRIP OF A DURATION EXCEEDING THREE DAYS
 Preliminary Approval (For International Trips Only)  Final Approval

1. School

2. Field Trip Dates

3. Teacher in Charge

4. Students involved

(a) Grade(s)/Courses (b) No. Eligible M F Total

No. Participating M F Total

5. Itinerary (Attach Proposed Itinerary)

6. Funding (Attach detailed budget including cost of meals and accommodations)
(a) Total cost of trip (b) Cost per student
(c) Funding source(s)
7. Supervision
Number of female staff Number of male staff
Other Adult Supervisor(s) Female Male Student/Supervisor Ratio
8. Method of transportation
9. Arrangements to cover school duties for staff on trip

10. Consultation and Communication with Legal Guardians: (Attach written communication and consultation
dates)

11. This field trip meets the requirements of the Simcoe County District School Board Policy 4430,
Administrative Procedures Memorandum A1061 - Field Trips, and all other applicable administrative
procedures and board policies.

Date Principal's Signature

Principal's Name (Please Print)

12. Request Approved  Request Not Approved 

Rationale

Date Signature of Superintendent of Education

Superintendent's Name (Please Print)
________________________________________________________
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FORM A1061 - 4

CHECKLIST FOR APPROVAL FOR FIELD TRIPS

School: _____________________________________

Trip: ________________________________________

Date of Trip: __________________________________

ITEM RECEIVED

Boat Inspection and Fire and Safety Regulations (if applicable)

Complete Trip Itinerary

Curriculum Expectations

Informed Consent/Permission Form for Educational Trips (A1061-7)

Number of Missed Instructional Days

OPHEA Training Information (if applicable)

Overnight/Out-Of-Province/International Field Trips - Consent Form

(A1061-2)

Parent Information

Payment Schedule for Parents/Guardians

Request for Approval of an International Field Trip or a Field Trip of a

Duration Exceeding Three Days (A1061-3)

Student Code of Behaviour re: drugs, alcohol, expectations

Supply Teacher Costs (how covered/budgeted)

Swimming Supervision (if applicable)

Tour Cancellation Insurance

Volunteer Transportation Authorization Form (if applicable) (A1061-6)

Waiver of Student Insurance Form (if applicable) (A1061-5)

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FORM A1061 - 5

WAIVER OF STUDENT INSURANCE FORM

Out-of-Province/Out-of-Country Field Trip

SCHOOL NAME:

LOCATION OF TRIP:

DATES OF TRIP:

STUDENT NAME:

I/We understand that the Simcoe County District School Board has adopted a new policy
whereby all children who participate in out-of-province/out of country field trips MUST have
Student Accident Insurance and/or Extended Health and Dental coverage.

I/We further understand that the above mentioned insurance is a mandatory condition of
participation.

I/We understand that the Board is not requiring parents to purchase the Board sponsored
student accident insurance plan. Student accident insurance can be obtained through any
carrier of your choice. Alternately extended health and dental plans may provide the additional
coverage.

□ I/We have purchased Student Accident Insurance Plan _____________________ (type)

through ______________________________ Insurance Company.

□ I/We have appropriate Extended Health and Dental coverage through another insurance
carrier/or workplace plan.

Signature of Parent/Guardian or Student [if age 18 or older]

Date

Printed Name of Parent/Guardian or Student

Please return this signed form to the student’s homeroom teacher

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FORM A1061 - 6

VOLUNTEER TRANSPORTATION AUTHORIZATION FORM

TO BE COMPLETED ANNUALLY BY EACH VOLUNTEER DRIVER

School: _________________________________________________________________________

Name of Driver:

Address:
Street/Rural Route City/Town Postal Code
Telephone: Home ( ) Work ( )

Type of Vehicle (year/make/model)

License Plate No.: Manufacturer’s Seating Capacity:

Registered Owner: Same as above or

Print Name

Driver is over 21 years of age? yes no

Class of license: (minimum G)

I will act as a volunteer driver, using the vehicle described above, for the Simcoe County District School
Board. I have a valid driver’s license, minimum automobile liability insurance coverage of $1,000,000
and the Ontario Policy Change Form (O.P.C.F) 44. I will provide the Board with prompt written notice
with all available particulars, of any accident/injury arising out of the use of this licensed automobile
during transportation of students to and from activities that are part of the school program. I will provide
an original Criminal Records Check. I am aware that children under 12 years of age should not be
permitted to ride in the front seat if the vehicle is equipped with passenger-side airbags.

NOTE: The board’s insurer provides third party liability coverage which would come into effect if the
primary automobile liability insurance on the vehicle above was exhausted.

Signature of Driver Date

I give permission to the above named driver to use my vehicle for transportation of students to and from
activities that are part of the school program. My vehicle has the minimum insurance coverage noted
above, is mechanically fit and there are seat belts in working condition for all passengers

Signature of Vehicle Owner Date

Signature of Principal or Designate Date

This information is gathered under authority of the Education Act R.S.O. 1990, c.E.2, part VI s.190 (2), the Highway Traffic Act R.S.O.
1990, c.H.8 O. Reg. 340/94 s.12, and the Insurance Act, R.S.O. 1990, c. I.8, part VI s.251, in accordance with the Municipal Freedom of
Information and Protection of Privacy Act, R.S.O. 1990, c. M.56. Information shall be used to arrange safe and lawful transportation of
students to and from activities that are part of school program. Questions regarding information collected in this form may be directed to
the School Principal or the Freedom of Information/Records Management Officer, 1170 Highway 26, Midhurst, ON, LOL 1X0 or at (705)
734-6363 ext. 11265.
 Administrative Procedures
Memorandum A1061
Page 21 of 22
FORM A1061 - 7

INFORMED CONSENT/PERMISSION FORM FOR EDUCATIONAL TRIPS

The ______________________________________________________________________________ is arranging

(Name of school)

(Description of activity and dates)

THIS FORM MUST BE READ AND SIGNED BY EVERY STUDENT OVER 17 YEARS OLD WHO WISHES TO
PARTICIPATE AND BYA PARENT OR GUARDIAN OF A PARTICIPATING STUDENT UNDER 18 YEARS OLD.

ELEMENTS OF RISK

Educational activity programs, such as _________________________ 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
______________________________________________________________________________________________:
(describe activity)
1.__________________________

2.__________________________

3.__________________________

The risk of sustaining these types of injuries result from the nature of the activity and can occur without any 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 engaged in the
activity.

If you choose to participate in ______________________ on ____________________, you must understand that you
bear the responsibility for any injury that might occur.

The Simcoe County District School Board does not provide accidental death, disability, dismemberment or medical
expense insurance on behalf of the students participating in this activity.

CONSENT FOR A VOLUNTEER DRIVER TO TRANSPORT (IF APPLICABLE)

I grant permission for ___________________ to be transported by a volunteer driver (employee, parent or other
adult) approved by the principal or designate. Volunteer drivers are over the age of 21, have a valid driver’s license,
have provided a criminal record check and are adequately insured.

ACKNOWLEDGEMENT

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

Signature of Student: _____________________________________ Date: _____________________

Signature of Parent/Guardian: ______________________________ Date: _____________________

(Students under 18 years)

PERMISSION

I give _________________________________ permission to participate in the

(name of student)
_____________________________________________ to be held on or about ______________________
(description of activity) (date)
 Administrative Procedures
Memorandum A1061
Page 22 of 22
FORM A1061 - 7

Signature of Parent/Guardian:_____________________________________ Date:____________________

(Student under 18 years)