Ogden School 600 Mckenzie Street

Thunder Bay, Ont. P7B4Z3

Telephone 622-9513;
Fax 623- 9436
Principal: A.
Pugliese

Dear Parents/ Guardians,

The Grade 6/7 class will be going to Boulder Bear Climbing Center on December 16th,
2016.

We will be walking to and from Boulder Bear Climbing Center, which is in the same
parking lot as the Silver City Movie Theatre. In order to have enough time climbing we will
be having an early lunch. Lunch will be 11:15 am - 11: 35am on that day. Students are
more than welcomed to bring snacks to eat at the climbing gym as well. We will be back
at the school for the end of the day.

Students will need to bring their own indoor shoes (or you can rent climbing shoes for an
extra $5.00) and wear comfortable clothing that they can climb in. Long stretchy pants are
recommended over shorts.

The Lakehead District School Board does not provide any accidental death, disability,
dismemberment / medical / dental expenses insurance on behalf of the students
participating in the activity. For coverage of injuries, you are encouraged to consider the
Student Accident Plan made available by the school to parents at the beginning and
throughout the school year. The risk of injury exists in every activity. Falls, collisions and
other incidents may occur and cause injury. Due to the very nature of some activities,
injuries may range from minor sprains to more serious injuries affecting the head, neck or
back. Some injuries can lead to paralysis or prove to be life threatening. These injuries
result from the nature of the activity and can occur without fault on either the part of the
student or the school board or its employees or agents or the facility where the activity is
taking place. By choosing to participate in the activity, you are assuming the risk of an
injury occurring. The chances of an injury occurring can be reduced by carefully following
instructions at all times while engaged in the activity. The Lakehead District School Board
attempts to manage as effectively as possible the risk involved for students while
participating in school activities.

Acknowledgment of Risks/Request to Participate/Informed Consent Agreement

I/We have read and understand the notices of accident insurance and elements of risk.
I/We hereby acknowledge and accept the risk inherent in the requested activity and
assume responsibility for my son/daughter/ward for personal health, medical, dental and
accident insurance coverages.

I/We request my/our child _______________________ to participate in indoor rock climbing on

December 16th,
(Student Name Printed)
2016 at Boulder Bear Climbing Center.
 I/We agree that the Lakehead District School Board or its employees, servant or agents
shall not be liable for any injury to my/our son/daughter/ward or loss or damage to
personal property arising from, or in any way resulting from the participation in the above
listed activities.

Signature of Parent/Guardian: _________________________________________ Date:

_______________

NO STUDENT CAN ATTEND A CLASS FIELD TRIP WITHOUT THIS SIGNED PERMISSON FORM.
PERMISSION BY PARENTS/GUARDIANS CAN NOT BE GIVEN OVER THE PHONE.