IPS Informed Consent 2021-22

IPS Informed Consent 2021-2022

This form is to be submitted annually and needs to be reviewed and signed by the student and parents.

This form can be saved at any time and a link will be supplied to you via email so that you can return to the form.

  • Although Island Pacific School staff is committed to operating the Island Pacific School program in as safe a manner as possible, program activities have certain inherent risks. The following information is presented here to ensure that you are informed of the potential risks.

    PLEASE READ CAREFULLY!

    Inclement weather is to be expected, including, but not limited to: heat, cold, wind, rain, snow, hail, sleet, lightning, and ultra-violet sun rays. Sudden, unexpected changes in weather are part of the wilderness experience. Appropriate equipment and clothing are necessary to minimize the risk of injury and/or illness from exposure to these elements. It is your responsibility to ensure that you have adequate equipment and clothing (participants are responsible for meeting their individual clothing needs, including footwear). Any equipment that you provide should be appropriate for the designated activity and comply with any and all provincial and federal regulations.

    Other hazards include, but are not limited to: equipment failure, variable water conditions, collision with exposed or unexposed hazards (including vessels), capsizing during paddling practice sessions and trips, rock fall, snow avalanches, falls on steep or difficult terrain, terrain which is dangerous or difficult to negotiate, becoming lost in remote areas, falls from the school bus or canoe/kayak trailer while loading equipment, forest fire, flooding, earthquakes, lightning strikes, animal attacks (bear, cougar, etc.), and ticks which may carry tick related diseases.

    Activities may include, but are not limited to: camping, hiking, kayaking, canoeing, cycling, skiing, snowboarding, rock climbing, map and compass navigation, regular Physical Education activities, games (including Ultimate), gear maintenance, loading and unloading vehicles (school bus, truck, trailer and borrowed or rental vehicles), cooking on camp stoves, lighting campfires, ropes course, swimming and other general outdoor activities. Transportation during the program, has risks as great as, or greater than, those associated with the program activities.

    Physical exertion is required for many of the activities; lack of physical fitness may contribute to injury or illness and result in discomfort. Some emotional stress is to be expected; an integral part of the program involves stretching comfort zones and psychological limits.

    Some of the activities will be held at sites that are not road accessible, and have no cellular phone or VHF radio reception, so there is no instant means of communication available. Should medical attention be required, remoteness may contribute to a delay.

    Because these risks are inherent in the Island Pacific School program activities, participating in the Island Pacific School program exposes the student to risk of injury or illness. These injuries and illnesses include, but are not limited to: death, paralysis due to serious neck and back injuries, brain damage, damage to internal organs, serious injuries to the bones, ligaments, joints and tendons, and general deterioration of health. Such injuries or illnesses can result not only in temporary loss of function, but also in serious impairment of future physical, psychological and social abilities, including the ability to earn a living.

    In an effort to make activities as safe as possible, the staff will instruct students concerning the safety precautions and correct mechanics of all skills. It is vital that students follow the staff’s instruction, and program policies, to decrease the possibility of injury or illness. Failure of the student to abide to such instructions will result in student assuming risk and may result in student being expelled. Our staff reserves the right to change or cancel scheduled activities without prior notice.

  • SIGNATURES

  • Parents will need to review the Explanation of Inherent Risks with their child to ensure the student fully understands before signing thier acknowledgement:

    I am aware of and accept the inherent risks associated with the Island Pacific School program activities as described on this form and do hereby give consent and agree, as follows:

    I am participating in this program out of my own free will and agree to follow all reasonable instructions and directions of the staff of Island Pacific School program.

    I understand that the possession or use of tobacco, alcohol, illegal drugs or any drug not disclosed on the medical form is strictly prohibited during Island Pacific School program activities and may result in immediate expulsion from the program.

  • PARENT/GUARDIAN SIGNATURE(S)

  • This form should be signed by both parents/guardians. However, in some cases, and where legally authorized, one parent/guardian may sign this form on behalf of both parents.

    Please select below where applicable.

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