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Adventures in Agassiz Out Trips

Consent & Waiver Form

The following consent form and signed waiver are a requirement prior to your child's participation in the District of Kent Adventures in Agassiz Out Trips. If you have any questions, please contact the Adventure Leader at summerrec@kentbc.ca or 604-796-8891.

Out Trip Information

Drop-off Time & Location

12:30 pm / CRCC

Pick-up Time & Location

4:00 pm / CRCC

Supervision

Summer Adventure Leaders

Ages

6 - 12 years

Out Trip Destinations & Dates

Please select which out trip(s) your child will be attending.

Harrison Spirit Trail Hike (July 23 - Public Transportation)

Goat Farm Visit (July 30 - Bike required)

Agassiz Bike Ride (August 6 - Bike required)

Agassiz Harrison Museum Visit (August 16 - Bike required)

Agassiz Library Visit (August 20 - Bike required)

Participant Information

Child's Name

Care Card Number

Child's Age

Parent/Guardian Information

Parent/Guardian #1

Relationship to Child

Primary Phone Number

Alternative Phone Number

Parent/Guardian #2

Relationship to Child

Primary Phone Number

Alternative Phone Number

Emergency Contact Information

Emergency Contact Name

Relationship to Child

Primary Phone Number

Alternative Phone Number

Pick-up & Walk Home Information

In the event that you are unable to pick up your child, the District of Kent Adventure Leaders must be notified of the alternative arrangements prior to the end of the Out Trip. Please list the names of the individuals who are authorized to pick up your child on your behalf and/or please consent with your signature below to permit your child to walk home unaccompanied.

Authorized Individual #1

Phone Number

Authorized Individual #2

Phone Number

I consent to my child walking home unaccompanied at the end of the out trip.

Clear

Health Information

Does your child have any health and/or behavioural concerns that may affect their participation in the Out Trips?

Yes

Please list any applicable allergies and/or medications.

Allergies

Medications