Queen Charlotte Intermediate School 150 North River Road Charlottetown, PE C1A 3L3 902-368-6970 Fax: 902-368-6983 KJ White Principal Dale McIsaac Vice Principal Let s Travel to Ottawa and Québec 2017-18 Trip Acceptance and Contract Travel Feb 19 th 23 rd, 2018 Trevor MacNeill Vice Principal Gladys Kickham Guidance Counselor In preparation for our upcoming trip, our teacher-chaperone team needs to figure out how many students wish to be part of this trip and to set out some guidelines for participating students. The guidelines will ensure that students will work diligently toward their trip in a positive manner and are clear on what is expected. We are also looking for parents who are interested in being chaperones. Therefore, students are expected to maintain a consistent strong effort academically while being a positive member of the Queen Charlotte school community during their grade nine year, and behave as they would at Queen Charlotte while on the trip. Should a problem arise on the trip, a student may be sent home at parents expense. If any one of these expectations is not met, the appropriate arrangements and/or actions will be taken. We look forward to your support and encouragement, as well as to a memorable trip. If for any reason your child is not able to participate in the trip, including behavioral issues; any refund is at the discretion of Target Tours. Thank for your support, Your Ottawa/Québec 2017-18 team at Queen Charlotte Please fill out the table below to indicate that both student and parents/guardians accept these conditions and expectations and return it to either Mr. Taggart or Mme. MacIsaac by Friday, Sept 29th, 2017, along with the first payment in the amount of $250. Post-dated cheques for October 27 and November 24 in the amount of $250 would also be appreciated, and will speed up the payment process. (cheques are preferred and may be made out to Queen Charlotte Intermediate School). We ask that this be placed in an envelope with the child s name and homeroom clearly stated. Payments are non-refundable. -------------------------------------------------------------------------------------------------------------------------------- Student name (please print) Birthdate (yr/mo/day) Class Student signature Parent/Guardian name (please print) Parent/Guardian signature Contact email address (please print clearly) Please indicate if you are interested in being a chaperone. Chaperone Y / N Name: 1 st payment Sept 29 - $250 2 nd payment Oct 27- $250 3 rd payment Nov 24 - $250 Final payment Jan 19 $TBD Insurance Option Students participating in the Ottawa/Québec trip have the option to obtain travel insurance at a special group rate of $64/person. This insurance will cover your child for any medical expenses not otherwise covered by provincial health care, expenses related to injury should that occur during the trip (ie: to bring a parent to the child should there be reason to do so), to send the child home for a medical emergency at home, for cancellation of the trip due to a medical issue prior to departure, expenses that may arise should we be storm stayed and require an extra day of travel, among other things. (details on QC website) Please Select One Option I would like to obtain this insurance. I have enclosed funds in the amount of $64. Cheques for this are made payable to QUEEN CHARLOTTE. It can be added to the first $250 deposit cheque for a total of $314. I am declining the option to obtain the travel insurance offered. I acknowledge that I will be responsible for any expenses related to medical care, trip cancellation due to illness, weather related delays/expenses, and other expenses that would otherwise be covered by the travel insurance. Parent Signature
Ottawa/Québec Trip 2017-18- Emergency Information Student Name of Birth (yr/mo/day) STUDENT cell phone number Provincial Health Card Number Parent/Emergency Contact Names Home Phone Work Phone Cell Phone Allergies, Medical Conditions, Illnesses of which to be aware Medications (Dosage and Frequency) Additional Important Information Parent Name Parent Signature If this information changes between the time it is filled out and departure date, please contact the school.
RELEASE SPECIFIC ACTIVITIES PLEASE READ CAREFULLY Name of school: Queen Charlotte Name of student: (please print) THIS FORM MUST BE READ AND SIGNED BY EVERY PARENT/GUARDIAN OF A STUDENT UNDER THE AGE OF 18 FOR A STUDENT TO PARTICIPATE IN THE SPECIFIED ACTIVITY(IES). THIS FORM MUST ALSO BE READ AND SIGNED BY EVERY STUDENT AGE 13 YEARS OF AGE OR OLDER WHO WISHES TO PARTICIPATE IN THE SPECIFIED ACTIVITY(IES). The above noted school is arranging an activity from February 19-23, 2018 to Ottawa and Quebec. Students will participate in: tubing, dog sledding, skating, walk tours, museum tours, bus travel, hotel stays, attending a hockey game and laser tag. 1. BACKGROUND The activity(ies) described above may involve certain elements of risk. Accidents may occur while students are participating in or travelling to and from such activities. An accident could occur and cause an injury, sickness or death, or damage to or loss of property without fault on the part of the Public Schools Branch, its employees, volunteers, representatives, agents, or the facility where the activity or event is taking place. In allowing the student to participate, the parent/guardian (if the student is under 18 years of age) assumes the potential risk. If a student is 18 years of age or over, the student assumes the potential risk. NOTE: If signed permission is not provided, the student will not be permitted to attend the activity(ies) described above. 2. ACKNOWLEDGEMENT AND PERMISSION I have read the above, and give permission for the student stated above to attend or participate in the activity(ies) described above, for which he/she may be eligible. I recognize the potential for injury, sickness or death, or damages or losses to property, and agree to assume the risks associated with the activity(ies) described above. I also recognize that failure on the part of the student to obey school rules or failing to follow the rules or instructions laid out by teachers, administrators, volunteers, chaperones, or others associated with the activity(ies) described above may result in the student being subjected to disciplinary action. The Public Schools Branch has in place Accidental Death, Dismemberment and Disability Insurance for students participating in school activities. Please refer to the Public Schools Branch website www.gov.pe.ca/edu/psb or contact your school for details on the coverage provided and procedures to follow for submitting claims. Signature of Parent/Guardian (for a student under the age of 18) Signature of Student (if student is 13 years of age or older) 3. RELEASE AND INDEMNIFICATION In consideration of the above-noted school allowing the student to participate in the activity(ies) listed above, I hereby release, hold harmless and indemnify, the above-noted school, the Public Schools Branch, its employees (including teachers and administrators), volunteers, agents, representatives and their respective heirs, executors, administrators, successors and assigns from any and all actions, causes of action, claims, suits and demands of whatever nature including negligence, (except for the gross negligence of the abovenoted school or the Public Schools Branch, its employees, volunteers, agents and representatives). I understand that this release applies to any injury, sickness or death and damages or losses of any kind, including property loss or damage sustained while participating in or being transported to or from this activity. Signature of Parent/Guardian (for a student under the age of 18) Signature of Student (if student is 13 years of age or older)
4. EMERGENCY SITUATIONS In case of a serious accident or illness, I request the school contact me. If I cannot be reached within a reasonable amount of time, and if the emergency contact and the family doctor likewise cannot be reached within a reasonable period of time (based on the contact information provided to the school), I authorize the school to take whatever immediate action is considered reasonably necessary in the circumstances which may include rendering basic first aid, obtaining and following instructions from a physician or other licensed health practitioner, and providing or arranging transportation of the student to the nearest or most appropriate health care facility. I hereby release the above-noted school, the Public Schools Branch, its employees, volunteers, agents, and representatives, and their respective heirs, executors, administrators, successors and assigns, from any and all liability for any injury, loss or damage which may be sustained as a result of providing treatment, including transportation to facilitate such treatment. I further agree to indemnify and hold harmless the above-noted school, the Public Schools Branch, its employees, volunteers, agents, representatives, and their respective heirs, executors, administrators, successors and assigns from any and all actions, causes of action, claims, suits and demands of whatever nature including negligence, except for the gross negligence of the school or the Public Schools Branch, its employees, volunteers and agents, or representatives which might be incurred by them as a result of or in relation to any treatment provided. Signature of Parent/Guardian
Queen Charlotte Intermediate School Ottawa and Quebec City 2018 4 Night February 19 th to 23 rd Itinerary Monday, February 19 th 6:00 am Coach departs Queen Charlotte Intermediate School parking lot. Please make sure your child is at the school by 5:30 am. 12:30 pm Rest stop in Edmundston, NB 3:30 pm Tubing at Valcartier Vacation Village 4:30 pm Italian Buffet Dinner at Valcartier Vacation Village 9:00 pm Check in to Hotel Valcartier, Valcartier, QC Security on duty tonight. Tuesday, February 20 th 6:30 am Complimentary hot breakfast and check-out at 8:00 am. 8:30 am Morning Guided Tour of Ste Anne de Beaupre, Montmorency Falls and Old Quebec 12:00 noon Lunch at Galleries des Capitale ($10.00 allowance per person) 2:00 pm Dog Sledding at Le Chenil La Poursuite 5:00 pm Dinner Buffet des Continents, Trois Rivières, QC 9:30 pm Check into Courtyard Marriott, Ottawa, ON. Security on duty tonight. Wednesday, February 21 st 7:00 am Complimentary hot breakfast 9:00 am Visit Museum of Nature 11:00 am Meet your step on guide for a tour of Ottawa. 1:00 pm Lunch at Rideau Centre ($10.00 allowance per person) 2:45 pm Visit Canadian War Museum 5:30 pm Dinner at Buffet des Continents, Gatineau, QC (Included) 7:00 pm Laser Tag at Laser Quest Ottawa 9:30 pm Return to the hotel. Security on duty tonight. Thursday, February 22 nd 7:30 am Complimentary hot breakfast 9:00 am Visit Canadian Science and Technology Museum on 417 Bus Lines school bus. 11:30 am Lunch at St. Laurent Shopping Centre ($10.00 allowance per person) 1:00 pm Tour the Canadian Parliament Buildings 2:30 pm Skating in the Rideau Canal - Enter off Daly Street 5:00 pm Dinner at Tucker s Marketplace 7:30 pm NHL Hockey Game at Scotia Bank Place between Tampa Bay Lightning and Ottawa Senators 10:30 pm Return to the hotel. Security on duty tonight. Friday, February 23 rd 6:00 am Complimentary hot breakfast 7:00 am Check out of the hotel and load luggage onto the motor coach. Regular drivers off duty today. 12:00 pm Lunch stop at Couche Tard, 665 Avenue Taniata, Lévis, QC Exit 318 4:00 pm Rest stop at Edmundston, NB 7:00 pm Rest stop and driver change in Lincoln, NB 11:15 pm Approximate arrival at Queen Charlotte Intermediate School Optional Manulife Insurance - details on reverse Optional Manulife Insurance Cost - $64.00 per person Coverage highlights include: - Emergency Medical Up to $5,000,000 CDN - Air Flight Accident Up to $100,000 - Worldwide Accident Up to $50,000 - Baggage and Personal Effects Up to $1,000 - Delayed Luggage Up to $400 - Delayed Sporting Equipment Up to $150 - Trip Cancellation Up to Sum Insured - Trip Interruption Unlimited