Cross Grade 8 (XPE) Permission form (Fall 2024)

CROSS GRADE 8 PE (XPE) Consent Form - Fall 2023

The SMUS Cross Grade 8 PE (XPE) program is designed to introduce students to a wide range of athletic experiences. All activities are provided at an introductory level. No previous experience is required. Parents/guardians are required to complete the following permission form. Some activities may also have an activity/venue-specific waiver.

Student First Name

Student Last Name

Swimming ability

Please indicate which of the following best matches the swimming ability of your child

Non-swimmer - They can't swim

They can swim 25 meters without stopping (minimum level required for swimming, paddleboarding, sailing, and sea kayaking)

They can swim 50 meters without stopping

They can swim 100 meters without stopping

Additional comments:

Please provide us with any other pertinent information that may be important in the planning of the XPE activities. (Examples: Student is afraid of heights/water...)

Parent/Guardian Information & Consent

Parent or Guardian Name

Cross Grade 8 PE Activities

Cross Grade 8 (XPE) activities include but are not limited to the following: Water Activities/swimming (Commonwealth Pool) Tennis (Cedar Hill Rec Centre and Oak Bay Rec Centre) Lawn Bowls (in Gordon Head) Golf (Henderson Golf Course) Rock Climbing (UVIC CARSA) Kickboxing/Wrestling (Zuma Martial Arts) Karate (Kenzen Sports) Gymnastics (Victoria Gymnastics or Inspire Sports) Dance (Pirouette Dance Studio and Stages Performing Arts School) Bike Spin Class/Group fitness (UVIC CARSA) Zumba/Pilates/Yoga/Squash/Fitness and Conditioning (SMUS Campus and fields) Disc Golf and Spikeball (Layritz and other local parks) Archery Other activities to be named

I have read the information provided by the school regarding the activities above and agree to my child's participation

Parent or Guardian Acknowledgement of Risk

As parent or guardian of the student, and having reviewed the material provided by SMUS about the activity, I hereby: a) Consent to the student participating in the indicated activities. b) Recognize and understand the inherent risks associated with the activities including but not limited to the hazards of vehicle travel, wilderness travel, water travel, accident/illness in places without nearby medical facilities, weather and other circumstances beyond the control of St. Michaels University School employees, related parties and agents. c) Authorize the activity leaders to consent to medical treatment for the student by any qualified medical practitioner as may be necessary in the event of an emergency. d) Understand the specific risks associated with the activities, including but not limited to: the use of a variety of diverse sporting equipment, accidental or incidental contact with other participants or equipment, swimming and water-sports, and travel within and outside the activity area. Consequences of these risks may result in physical or emotional injury, paralysis, drowning, death or damage to property or third parties. e) Understand that even though there are a variety of measures and practices in place to reduce the frequency and severity of injury/illness, residual risk remains. Accidents and injuries can still occur.

I acknowledge the information above, as well as the risks and hazards and consent to my child participating in the Middle School Cross Grade 8 PE (XPE) activities