(Students Under 18 Years)

The Upper Canada District School Board is arranging bus service for (name of
school) to attend the 2015 International Plowing Match.
_____________________________________________________________________________________
Due to recent provincial job action, our staff will be unable to attend and provide
supervision for our offsite trip to the 2015 International Plowing Match on
Wednesday, September 23, 2015.
However, we would like to offer access to this much anticipated community event
by providing transportation and booking arrangements only. Please be advised the
school board will not be responsible for providing supervision of students on this
trip.
In order for your child to be released from class to participate, they will need to be
accompanied by their parent. The Parent will be required to provide
supervision of their child(ren) at all times for the entirety of the event.
**
Transportation Information
Bus Leaves Rothwell-Osnabruck School at 9:15am for International Plowing Match
Bus Departs from International Plowing Match at 1:45pm and returns to RothwellOsnabruck at 2:15pm
**
Booking Information
To avoid delays at the gate, Rothwell-Osnabruck School will collect and process
admission fees on your behalf. Gate fees for this event are as follows:
Children 6-18: $5.00
Adults: $17.00 (To be Paid by Parents)
THIS FORM MUST BE READ AND SIGNED BY THE PARENT WHO WISHES TO
PARTICIPATE NO LATER THAN TUESDAY, SEPTEMBER 22, 2015
ELEMENTS OF RISK:
Educational activity programs, such as the International Plowing Match 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 slip, trip fall, sprain and/or strain. Encounters
with livestock may result in kicks and/or animal bites.

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, the parent, 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 or 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 The International Plowing Match on September 23,
2015, you must understand that you bear the responsibility for any injury that might
occur.
The Upper Canada District School Board does not provide accidental death,
disability, dismemberment or medical expense insurance on behalf of the students
participating in this activity. It is strongly recommended that you purchase Student
Accident Insurance, particularly if you do not have a benefit plan through your work,
to cover damage, loss and expense sustained in the event of an accident. For
additional information on Student Accident Insurance, please go to the following
website http://www.insuremykids.com/about.aspx or call 1-800-463-5437
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. BY GIVING
PERMISSION BELOW YOUR CHILD WILL BE ENTERED INTO OUR ATTENDANCE
SYSTEM AS A PARENT APPROVED ABSENCE FOR Wednesday September 23 rd, 2015.
PERMISSION
I give _______________________________ (name of student(s)) permission to participate
in the
International Plowing Match to be held on Wednesday September 23 rd, 2015. If you
are attending please go to #1, if you are NOT attending, please go to #2.
PLEASE NOTE THAT A PARENT/GUARDIAN CAN ONLY SUPERVISE A
MAXIMUM OF 5 STUDENTS
#1. Yes, __________________________________ (Parents Name), I will be
attending the 2015 International Plowing Match and am aware that I will
be responsible to provide supervision for my child(ren) for the entirety of
the event including transportation to and from. I have also enclosed the
$17 entry fee for adults.
Signature of Parent/Guardian: ______________________________ Date:
_______________________

#2. No, __________________________________ (Parents Name), I will NOT be

attending the 2015 International Plowing Match with my child(ren) and I
have made arrangements for my child to be supervised by,
_________________________________ (name of Supervising Parent), who will be
responsible for providing supervision for my child(ren) for the entirety of
the event including transportation to and from.
Signature of Parent/Guardian:__________________________________________