Grade 5 Zoo Excursion Permission Form NOV 2022

Form 511C
Aug. 30, 2004

Page 1 of 2
Parent/Guardian Permission for Excursion
The collection and retention of the information requested on this form is authorized and governed
by the Ontario Education Act and the Municipal Freedom of Information and Protection of Privacy Act.
School: Seneca Hill Public School Telephone: (416) 395-2840

Teacher(s): Luong, Virginia Grade/Class:
Student: Date of Excursion: Nov 09, 2022
Nature of Activity: Curriculum Connections
Destination: Toronto Zoo
To Parents and Guardian:
The purpose of this form is to inform you about the excursion and to seek your support and permission for your child/ward to
participate. This information may be shared as necessary with adults supervising the excursion.
This is an important document. Please ensure that someone is able to translate and explain this document to you.
Purpose of the excursion: Workshop and tours
Itinerary
Program/itinerary: Tours of pavilions and lunch in the morning, Workshop at 12:15 to 1p.m.
Departure/Return Dates Nov 09, 2022 9:15 AM - Nov 09, 2022 2:00 PM
In exceptional circumstances, dates and times may change. Every effort will be made to communicate these changes to you ahead of time.
Method of Travel School Bus
*Approval of the principal is required for all volunteer drivers. The school will make every effort to ensure that parent/guardian consent is obtained for each excursion
for students to travel in private vehicles.
Requirements for Participants Clothing and Equipment: appropriate for weather; Food/snacks: Litterless lunch
*** Please pay via School Cash Online ***

As part of the excursion, students will be participating in the following high-care activities. These activities involve increased risk or
special safety considerations, or require special qualifications or certification for supervision. Appropriate supervision will be
provided.
Accommodation (if required)
Financial Arrangements
Total cost per student: $ 23.00 Deposit required: $ 0.00 Payable to:
Excursion Staff
Teacher: Luong, Virginia School contact during the excursion:
Staff Supervisors: Kapoor, Neelam; Lee, Ernest; Dergalstanian, Ida
Volunteer Supervisors (if known):

Teacher Luong, Virginia Signature Luong, Virginia Date Oct 31, 2022
Administrator Azim, Sharon Signature Azim, Sharon Date Oct 31, 2022
Form 511C
Aug. 30, 2004
Page 2 of 2
Please sign in either the YES or the NO box and return

this form to the teacher by:_______________________________
Nov 04, 2022
YES
I/we give permission for my/our child/ward, , to participate
in the excursion
to Toronto Zoo on (date) Nov 09, 2022
Emergency Contact: Emergency Phone Number:
I/we give permission for my/our child/ward to be transported in a private vehicle (adult driver) , private vehicle
(student driver) who has been authorized by the principal.
Parent Signature
Is there any change in medical information or a medical reason why your child should not participate in the activity, or which may
lead him/her to require special attention during the activity?
Should it become necessary for my/our child/ward to have medical care, I/we hereby give the teacher permission to use her/his best
judgment in obtaining the best of such service for my/our child/ward. I/we understand that any cost will be my/our responsibility. I/we
also understand that in the event of illness or accident, I/we will be notified as soon as possible.
Name of Parent/Guardian
(printed name of parent/guardian)
Signature of Parent/Guardian Today’s date:

(or student, if 18 years old or older)
For students 18 years old or older, it is strongly recommended that the parent/guardian also sign this form.
I wish to volunteer on this trip: Yes No

NO
I/we do not give permission for my/our child, , to
participate in the excursion to Toronto Zoo on
(date) Nov 09, 2022
Name of Parent/Guardian .
(printed name of parent/guardian)

Notice of Collection
Personal information on this form is collected under the authority of sections 58.5(1) and 171.(1), paragraph 28 of Education
Act, R.S.O. 1990, c.E.2 (as amended) and will be used by the Toronto District School Board to support the planning and
programming of student participation in co-curricular and extra-curricular excursions and activities. The information is retained
in accordance with Municipal Freedom of Information and Protection of Privacy Act, R.S.O. 1990, c. M. 56 and may also be
disclosed to authorized staff in order to administer the above purposes. Questions regarding this collection should be directed
to your school principal or David Hawker-Budlovsky, Centrally Assigned Principal, School Operations, Outdoor Education at:
[email protected], or 140 Borough Drive, Toronto, Ontario, M1P 4N6, or 416-396-3408.

Grade 5 Zoo Excursion Permission Form NOV 2022

Uploaded by

Copyright:

Available Formats

Grade 5 Zoo Excursion Permission Form NOV 2022

Uploaded by

Document Information

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Grade 5 Zoo Excursion Permission Form NOV 2022

Uploaded by

Copyright:

Available Formats

Form 511C

Aug. 30, 2004

School: Seneca Hill Public School Telephone: (416) 395-2840

Purpose of the excursion: Workshop and tours

Method of Travel School Bus

* Please pay via School Cash Online *

Accommodation (if required)

Volunteer Supervisors (if known):

Please sign in either the YES or the NO box and return

to Toronto Zoo on (date) Nov 09, 2022

Emergency Contact: Emergency Phone Number:

Signature of Parent/Guardian Today’s date:

I wish to volunteer on this trip: Yes No

Signature of Parent/Guardian Today’s date:

participate in the excursion to Toronto Zoo on

(date) Nov 09, 2022

Signature of Parent/Guardian Today’s date:

You might also like