RiverWatch Science Program

Field Trip Permission Form

This signed form is to be given to the teacher and brought on the field trip.

Student's Name: _____________________________________________________________

School: _______________________________________

Trip Date: ______________________

Science Teacher: ________________________________________   Class: ____________

___ I have read all six pages of the trip newsletter.

___	I am aware and accept that there are potential hazards during access to a river, a river raft float and a science study.

___	I understand that this permission to participate is based on informed consent. Students under the age of 18 cannot sign a waiver and parents cannot sign on their behalf. This permission form does not constitute a waiver of liability. Only teachers and adult supervisors are asked to sign a waiver.

___	Permission is given to participate in this river access, a raft float, science activities and any interview, filming or photography conducted by RiverWatch staff or news media. Quotes and images may be used for promotion and education.

___ This student will adhere to all school regulations and all field trip expectations.

___ If space allows, I would like to participate as a parent volunteer at no cost.

___ The attached cheque or cash in the amount of $_________

is payable to _____________________________________________ School.

Questions or Comments: _____________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

Please complete and sign the reverse side of this form…

RiverWatch Science Field Trip

Student Information Form

This form is to be given to the teacher; brought on the trip; and used only in the event of an emergency

Student's name _____________________________________________________________________

Home address ______________________________________________________________________

Postal code ____________________________         Home phone ____________________________

Age ________       Alberta Health Care Number _____________________________

Parents' names   _________________________________     ________________________________

Work phone #s   _________________________________     ________________________________

Emergency contact __________________________________________________________________

Family doctor _______________________________________________________________________

Family dentist ______________________________________________________________________

Medications ________________________________________________________________________

Contact lenses ______________________________________________________________________

Fitness level ________________________________________________________________________

Swimming ability ____________________________________________________________________

Parent Signature: _________________________________________   Date: ____________________