Newcomer Youth Program

(Snow Tubing)
Participant/Parent/Guardian Permission Form
To Participants/Parents and Guardians:

This form is to ask permission for you/your child/ward to participate on this trip. This information
may be shared with adults supervising the trip.

Important:

We are making significant efforts to make everyone safe during this activity. Please read the precautionary
measures we have in place. Please fill out the Pre-screening form attached prior to arriving at the meet up
location.

PLEASE INFORM STAFF AHEAD OF TIME IF YOUR CHILD/WARD EXHIBITS ANY COVID-19 RELATED SYMPTOMS
INCLUDING BUT NOT LIMITED TO:

 RUNNY NOSE SHORTNESS OF BREATH

 RUNNY NOSE

 CHEST PAIN

 LOSS OF SENSE OF SMELL/TASTE

 FEVER

 NEW OR WORSENING COUGH

Please note:

If in any case you or your child/ward feel unwell the day of the trip, please stay home and inform the staff.

If symptoms are detected and there are indications that you or your child/ward might not be feeling well prior
to the departure, you or your child/ward will NOT be able to attend this activity.

Please understand that we have these measures in place in an effort to keep everyone safe. Should you have any
questions or concerns about the COVID-19 screening form and the precautions we have in place for this trip,
please don’t hesitate to contact the staff listed below.
Staff Present:
John Kok Cell phone: 416-206-8043
Somya Khanal Cell phone: 416-278-9729
Kitt Azores Cell phone: 416-473-3260

Things to bring:
• Piece of identification such as health card
• Dinner (There is a café if you wish to purchase food there)
• Wear comfortable shoes
• Wear a jacket/sweater
• Gloves, scarf, toque
• Water Bottle

Purpose
This trip will introduce newcomer youth to important aspects of Canadian culture and recreation. On
this trip, youth will get to experience a fun winter sport and socialize with other newcomer youth. They
will also be able to practice their English with other youth and with staff. Activities during the trip will be
led by West Neighborhood House staff.
Leaving: Friday 16th of February, 2024 at 2:30pm St. George Subway Station

Returning: Friday 16th of February, 2024 at 8:00pm St. George Subway Station

Transportation: Chartered school bus

Event Location: The ROC, 26557 Civic Centre Rd, RR 2, Keswick, ON L4P 3G

This trip is FREE! All costs will be covered by the program.

Participant Information:

FIRST NAME LAST NAME GENDER MALE / FEMALE /

OTHER

PERMANENT RESIDENT NUMBER (PR CARD #) / REFUGEE ID NUMBER DATE OF BIRTH MM / DD / YY

MANDATORY!
HOME PHONE- CELL PHONE - HEALTH CARD NUMBER-

YES,
I give permission for me/my child/ward, ___________ to participate in the West Neighbourhood House
Newcomer Youth Program Trip to go to the Snow Tubing trip at The ROC, on Friday 16th of February,
2024. I also give permission for me/my child/ward to travel by a chartered school bus with staff from
West Neighbourhood House Newcomer Youth Program.
Are there any medical issues that will prevent me/your child/ward from participating in certain
activities, or which may lead him/her to require special attention during the activity?

Emergency Contact Name:

Emergency (Daytime) Phone Number:

Media Consent (optional)

I, ____________________ (print name), hereby give West Neighbourhood House the permission to
photograph or videotape me/my child’s image and to display, publish or use these images for use in
West Neighbourhood House promotional media and publications including the West Neighbourhood
House website and its social media outlets.
I have read this Media Release Consent Form and I fully understand the contents and meaning of this
release. I understand that I am free to contact West Neighbourhood House staff if I have any questions
regarding this release.

Outings Permission Form

I, the undersigned, hereby give West Neighbourhood House Personnel permission to accompany
me/my child/ward on this to go to the Snow Tubing trip at The ROC, on Friday 16th of February, 2024. I
understand that West Neighbourhood House, its officers, directors, employees, and agents shall not be
liable for any injury to me/my child/ward or loss or damage to personal property arising from or
resulting from my/the child’s/ward’s participation in the trip and its activities.
Should it be necessary for me/my child/ward to have medical care, I hereby give the staff permission to
use her/his best judgment in obtaining the best of such service for me/my child/ward. I understand that
any cost will be my responsibility. I also understand that in the event of illness or accidents, I will be
notified as soon as possible.
Name of Participant/Parent or Legal Guardian: _____________________

SIGNATURE OF PARTICIPANT (if 18 or older) / PARENT/GUARDIAN (if subject under DATE MM / DD / YY

age 18)

For participants 18 years old or older, it is recommended that a parent/ guardian sign this form. However, participants can sign
their own for.