Francis Libermann Catholic High School 4640 Finch Avenue East Scarborough, Ontario M1S 4G2 Telephone (416) 393 – 5524 Fax (416) 393 – 5891
September 21, 2009 Dear Parent/Guardian: Congratulations! Your son/daughter has been chosen to compete in Francis Libermann’s Varsity Athletic program! Together with your child, please read and sign the accompanying forms: 1. Athlete’s Contract 2. Parent Consent/Medical Release Please note a mandatory fee of $50.00 is required to cover the cost of the ‘Athletic Banquet’ and a ‘Participant Fee’. If your son/daughter participates in more than one sport there is an additional fee of $20.00. The Participation Fee is to help cover tournament expenses and transportation. Receipts are available upon request. Forms and fees must be submitted as soon as possible so that the Athlete may represent the school in upcoming competitions. A schedule of the games can be found under the Athletics section of our school website: http://www.libermann.tcdsb.org Thank you for your support and assistance in this matter. If you have any questions, please contact us at any time. Sincerely,
Nick Cirone and Ted Galka Athletics
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Athletic Participation Policy Contract I understand that by joining the ____________________________ team, or extra-curricular club, I am representing Francis Libermann and must fulfill the following: 1. Students must be working to the best of their ability in all classes to play on a school team. 2. Attendance and punctuality for al classes is mandatory. 3. All students are expected to follow the behaviour code set out in the student agenda (which can also be found on the school website). 4. Any detention or suspension must be served first. Students are not allowed to practice or play the day of a detention or suspension. 5. Be present for all practices and competitions as requested by the coach. 6. When a student athlete quits or is asked to leave the team they forgo any future participation in Libermann athletics, for the remainder of the current academic year. 7. In all cases, if appropriate and necessary, the Principal, in consultation with the Team Coach, Athletic Director and Vice-Principals, have the authority to remove a student from a school team and thus refusing them access to a Francis Libermann school team.
By signing this contract, I agree to and understand the conditions outlined above.
_________________________________ Student signature
_________________________________ Parent/Guardian Signature 2
TORONTO CATHOLIC DISTRICT SCHOOL BOARD PARENT/GUARDIAN PERMISSION FORM – ALL EXCURSIONS School: _______________________________________________________ I/We give permission for my/our child, __________________________________________ Student’s full name
To go on the school excursion to: ____________________________________________________________ Nature and purpose of the excursion: _________________________________________________________ Departure time from school: ________________
Departure Date: ________________________ Y-M-D
Anticipated return time to school: ___________________
Return Date: _______________________ Y-M-D
Your child will be transported by (check all that are appropriate):
Charter Bus
Public Transit
Volunteer Driver
Student Volunteer Driver
Other (please specify) __________________________________________________________________ Teacher(s) in Charge/Supervisors:
(1) __________________________________________ (2) __________________________________________ (3) __________________________________________
Cost of Excursion
$_________________ per student:
Cost of Excursion
$________________________ per supervisor: (if applicable)
Extra costs for students: ___________________________________________________________________
The receipt of the following information is acknowledged by the signature of the parent or guardian. 1. If an excursion is organized without approval being obtained, the Board declines to assume financial or other responsibility of personal liability incurred by students and/or their parent(s)/guardian(s) in connection with their private arrangements for excursions which are not part of the school curriculum. 2. Each child’s parent(s)/guardian(s) is to receive a copy of the pertinent information contained on the approval form 3. Please indicate on the back of this form or on the Student Health Information Form (if an overnight trip) any relevant medical information concerning your child. 4. If an alternate travel, accommodation or activity plan for your child has been made, list details on the reverse side and sign that your permission is given for these changes. 5. Parents/Guardians are responsible to make the necessary arrangements if, for any reason, it becomes necessary to send their child(ren) home prior to the end of the excursion. The Board is in no way responsible for reimbursing parents/guardians if this situation occurs.
_____________________________________ Principal’s Signature
(indicates approval of this/these events). (To be signed before copies are sent for signature of parent/guardian)
____________________________________
_________________________ Date
_________________________
Signature of Parent or Guardian (Signature of student if over 18 years of age)
Date (April 2007)
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TORONTO CATHOLIC DISTRICT SCHOOL BOARD STUDENT’S HEALTH AND SAFETY INFORMATION FORM The information on this form is collected under the authority of the Education Act, R.S.O. 1991, Section170(1) and will be used for administration of school excursions and in the event of a medical emergency. If you have any questions regarding the collection or use of this information, please contact the school Principal.
School Name: __________________________________________________________ Name of Child: __________________________ Date of Birth:____________ Sex: ___ Last Name
First Name
Y- M- D
M or F
Student’s Home Address: _______________________________________________________________ Number
Street
City
Postal Code
Student’s Home Phone Number: ________________________________ Father’s (Guardian’s) Name:
__________________________________________________
Father’s (Guardian’s) Address:
_________________________________________________
(If different from student’s)
Place of Employment:
________________________________ Phone: _________________
Mother’s (Guardian’s) Name:
__________________________________________________
Mother’s (Guardian’s) Address:
________________________________________________
(If different from student’s)
Place of Employment:
_______________________________ Phone: _________________
Family Doctor: __________________________________________ Phone: ______________________ Alternate:
______________________________________ Phone: __________________
OHIP Health Card No:
___________________________ Blood Type (if known): __________
Does your child have any special condition which must or should be taken into consideration in his/her participation in a full academic and physical program?
Allergy: _______________________________________________________________ Asthma: _______________________________________________________________ Diabetes: ______________________________________________________________ Epilepsy: ______________________________________________________________ Feet or Legs: ___________________________________________________________ Heart: ________________________________________________________________ Skin: _________________________________________________________________ Rheumatic Fever: _______________________________________________________ (Page 1 of 2) (April 2007)
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TORONTO CATHOLIC DISTRICT SCHOOL BOARD STUDENT’S HEALTH AND SAFETY INFORMATION FORM Recent illness or operation: _________________________________________________________ _______________________________________________________________________________ Other: _________________________________________________________________________ _______________________________________________________________________________ Does your child carry any medication for the above-mentioned condition(s)? If so, please give details: (e.g. Epi Pen) _______________________________________________________________________________ _______________________________________________________________________________ Does you child carry an Epi Pen?
Yes
No
Has he/she any drug allergy or sensitivity? If so, please give details: _______________________________________________________________________________ Has he/she any serum sensitivity? If so, please give details: _______________________________________________________________________________ _______________________________________________________________________________ Date of last tetanus shot (if known): __________________________________________________ If there are any medical details that you feel might be of some assistance to the teacher to ensure the safety of your child, please contact the teacher at school or use the space below to inform the teacher of these details. _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ __________________________________________ Signature of Parent or Guardian
__________________________ Date
(Signature of student if over 18 years of age)
______________________________________ Signature of Supervisor-in-charge of Excursion
__________________________ Date (Page 2 of 2)
(April 2007)
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TORONTO CATHOLIC DISTRICT SCHOOL BOARD CONSENT TO MEDICAL TREATMENT (a) When on Field Trips and
(b) When parents cannot be contacted
The information on this form is collected under the authority of the Education Act, R.S.O. 1991, Section170(1) and will be used for administration of school excursions and in the event of a medical emergency. If you have any questions regarding the collection or use of this information, please contact the school Principal.
To:
Any Qualified Health Care Provider
CONSENT TO MEDICAL TREATMENT I hereby consent to the administration of any medical treatment deemed by any qualified medical practitioner to be necessary for the health and welfare of my child, ____________________________________________ Child’s Name
including the administration of an anaesthetic and the performance of any necessary operation during the period ___________________________ to Y–M–D
_______________________. Y–M–D
Dated at _________________________ this _______________ day of _____________ Health Card Number: ___________________________________
______________________________________ Signature of Parent or Guardian
__________________________ Date
(Signature of student if over 18 years of age)
(April 2007)
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