Consent for Participation in the 2015 International Youth Leadership Summit School Address, Calgary, AB T2X X4X t | 403-XXX-XXXX f | 403-XXX-XXXX | email@cbe.ab.ca Please note, students MUST bring signed consent forms to the IYLS in order to receive their registration package and participate in the day’s events. Without signed forms they will not be allowed entry. I, _____________________________, allow my son/daughter ___________________ to participate in the 2015 International Youth Leadership Summit (IYLS) on Saturday, May 2nd, 2015 at the CBE Education Centre, 1221 8th Street SW, Calgary, T2R 0L4. I understand that my son/daughter’s involvement in this summit is completely voluntary and also understand, and freely accept, that there are some anticipated risks in this activity that include but are not limited to: Activity Hazard(s)/Risk(s) Summit Slips, Trips and Falls Fire and Evacuation Unfamiliar Environment Students Getting Lost and/or separated from the group Pre-Existing Medical Conditions Contact with Other Participants Lunch Choking and Allergies Terms & Conditions: § I am satisfied that I have been informed of my right to obtain as much information about this program, or activity as I feel necessary, including information beyond that provided to me by the school or Board to the extent that I require and am not, in any way, relying solely upon information provided by the Calgary Board of Education respecting the nature and extent of the risks and hazards associated with the program or activity. § I freely and voluntarily assume the risks and hazards inherent in the nature of the program or activity and understand and acknowledge that my child, as a participant, may suffer personal and potentially serious injury due to an unforeseeable or fortuitous event. § My child has been informed that he/she is to abide by the rules and regulations including directions and instructions from the school’s teachers, instructors, and supervisors as imposed on students while participating in the program or activities. This shall include his/her participation in all of the sessions and meet all prerequisites prior to his/her participation in the activity or program. § In the event that my child fails to abide by the rules and regulations imposed on the student while participating in the program or activities, disciplinary action may either require that he/she not participate in the program or activity, or that I will be contacted to have him/her picked up, unless I have permitted my child to pursue alternate means of transportation as identified herein. § I acknowledge that it is my responsibility to advise the Board of any medical § or health concerns of my child which may affect his/her participation in the stated program or activity. I consent that the Board, through its employees, agents, and officers at the school may secure such medical advice and services as those individuals, in their sole discretion, may deem necessary for my child’s health and safety, and that I shall be financially responsible for such advice and services. I understand that comments/feedback from participants in this event will be coded in such a way that a student’s name or identifying information will not be attached to the information. All data collected will be reported and used in aggregate form. I understand that there will be video recording and photographs taken at this event. These may be posted in a variety of locations to share this experience with administrators, teachers, the Board of Trustees, and fellow conference goers. The media captured may appear on our jurisdiction’s website or on our Twitter feed (iyls2015). I understand that by attending this event my son’s/daughter’s image may appear in the video/photographs. I also understand that my child may be asked to comment on camera, but is free to decline. I freely accept the risks and allow my child to participate in the IYLS. ________________________ Student Name (printed) _________________________ Parent/Guardian Signature ________________ Date Thank you for allowing your child to participate in this exciting event! Although there are no fees for participating in the summit we are happily accepting nonperishable food donations and toiletry items on behalf of the Inter-Faith Food Bank and The Drop-In Centre. Sincerely, Aubrey Fletcher System Assistant Principal, Global Learning t | 403-817-7721 anfletcher@cbe.ab.ca 2|2