Lifetime Skills Participation Agreement

I____________________ agree to follow policies and procedures set forth for this class
by the instructors and public facilities that are utilized.
Policies:
1. I am responsible for transportation to and from off campus sites and obeying all
traffic laws.
2. I am to do exactly what is instructed to do by all supervisors i.e.: teachers, guest
instructors and offsite staff.
. I will follow all school rules and regulations and any additional rules pertaining to
this activity.
!. I will arrive on time for all offsite activities and stay until dismissed by
supervisor.
". Instructors will not transport students.
I understand that I will receive ONE warning and my parents#guardians will be contacted
for minor discipline issues. Second minor discipline issue will result in expulsion from
class and receive a failing grade.
$a%or discipline issues including but not limited to: theft, vandalism, harassment, assault,
drug, tobacco or alcohol paraphernalia#possession will be turned over for prosecution by
&chool 'esource (fficer and local authorities and will result in automatic expulsion
from class and receive a failing grade.
Assumption of Risk
)y signing this form, you are agreeing that you *now, understand, and appreciate the
ris*s inherent to +ifetime &*ills ,ctivities. -urther, you agree to accept and assume those
ris*s, and you agree to release, waive, discharge and covenant not to sue )illings &enior
.igh &chool, &chool /istrict 02, promoters, volunteers, officials, offsite activity
providers or anyone associated with the )illings &enior .igh +ifetime &*ills class.
-ailure of 1arent#2uardian and &tudent to agree, sign and return this form by 3ednesday,
4##1! will result in automatic drop from the class.
&tudent5s 6ame 7print8________________________
&tudent5s &ignature___________________________
/ate___________________
1arent# 2uardian5s 6ame 7print8 __________________________________
1arent# 2uardian5s &ignature _____________________________________
/ate___________________
illings Pu!lic Sc"ools
Sc"ool Related Off #ampus Activit$
9he purpose of this sheet is to inform parents of an off campus school related activity. In the event you
would need to communicate with your child during this time frame, you would *now the time : location of
the off campus event.
,ctivity: +ifetime s*ill activities 7included but not limited to8 bowling, golf, archery, swimming, archery,
roc* climbing.
1urpose of the off campus activity: +ifetime &*ills ,dvanced 1;
&upervision: 9orey .ammer
9ransportation: 1ersonal <ehicles
'e=uirements for students: >ome to class prepared to participate 7according to teacher8 : pay for activity.
/ate of activity: /aily +ocation: <aries 9ime: <aries
;xpectations : instructions: I understand the student is expected, : the student has been instructed:
a. 9o do exactly what he#she is instructed to do by the supervisors.
b. 9o follow all school rules : regulations : any additional rules pertaining to this activity.
$edical information#concerns:
1lease chec* : include a short explanation.
___ ,llergies____________ ____/iabetes___________
___,sthma_____________ ____&eizures___________
___$eds during school day_______________________________________________
___1hysical restrictions__________________________________________________
___(ther______________________________________________________________
If any emergency medical procedures or treatment are re=uired during this trip, I consent to the trip
supervisor ta*ing, arranging for or consenting to the procedures or treatment necessary in his#her or their
decision.
.ospital >hoice:_________________________________________________________
/octor:____________________________ 1hone:_______________________
/entist:____________________________ 1hone:_______________________
____________________________ ______________________________
1rint &tudent5s 6ame ,ddress
____________________________ __________________________________
&ignature of 1arent#2uardian 1arent5s emergency phone number if needed
/ate signed:___________________
,ny other parental concerns regarding this activity:
________________________________________________________________________