A Tradition of Excellence

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1 A Tradition of Excellence November Via Electronic Mail Donald P O Neil RE: Response to FOIA Request Thank you for writing to Hinsdale Township High School District 86 with your request for information pursuant to the Illinois Freedom of Information Act ( FOIA ), 5 ILCS 140/1 et seq., received on October 19, 2016, and extended to November 2, You requested the following: 1. Blank copy of waiver students were requested to sign in order tp dive in Dist. 86 pools. 2. Copy of any documented stating a school did not want to participate in diving at Dist. 86 pools. Enclosed is documentation responsive to your request. As the District s FOIA Officer, I am responsible for the District s response to your FOIA request. This letter and enclosures are intended to be fully responsive to your specific request. If I have misunderstood your request in any way, please clarify the request in writing to me. Sincerely, FOIA Officer Hinsdale Township High School District FOIA-Officer@hinsdale86.org 2017 FOIA Log 5500 South Grant Street Hinsdale, IL d86.hinsdale86.org

2 PARENTAL CONSENT FOR POOL USE The students in [insert activity or class] will be using the pool at either Hinsdale Central High School or at Hinsdale South High School. Hinsdale Township High School District No. 86 ( District ) requires that the parents/guardians of a student who wishes to use the pool at Hinsdale Central High School or the pool at Hinsdale South High School give written consent and provide insurance coverage information prior to use of either pool. Please check the appropriate box and, if applicable, choose the appropriate insurance coverage. I give consent for my child,, to use the pool at either Hinsdale Central High School or at Hinsdale South High School. My child s insurance coverage, aside from the regular school student accident insurance, includes: ( ) Accident insurance. List insurance company and address: ( ) No accident insurance, but I understand that medical expenses resulting from accidents that may occur on this trip/activity are solely my responsibility. I do not give consent for my child,, to use the pool at either Hinsdale Central High School or at Hinsdale South High School. In the event of my child s illness or injury, I hereby authorize District school personnel to provide emergency first aid and, if necessary, to take my child to the nearest hospital or emergency care facility. My signature below indicates that I agree to assume all responsibility and expenses incurred as a result of any emergency care needed. Should school or emergency personnel have difficulty reaching me, please contact: Secondary Emergency Contact (Relation to Child) Phone List any of your child s special medical conditions of which we should be aware in the event of an emergency (e.g., seizures, allergies): Doctor s Name: Doctor s Phone #: If your child will require prescription medication, an Epi-pen or asthma inhaler, or non-prescription, overthe-counter medication during the use of the pool at either Hinsdale Central High School or at Hinsdale South High School, you MUST complete and return the appropriate Consent and Physician Forms. Parent/Guardian Signature Date: Phone

3 POOL USE WAIVER Acknowledgment of Risk, Assumption of Responsibility Please read this form carefully and be aware that by signing this form and allowing your child to use the pool at either Hinsdale Central High School or at Hinsdale South High School, you will be waiving and releasing any and all claims for injuries that your child might sustain as a result of your child s use of the pool at either Hinsdale Central High School or at Hinsdale South High School. I acknowledge and understand that my child s use of the pool at either Hinsdale Central High School or at Hinsdale South High School involves physical activities, which include, but are not limited to, swimming and diving. I affirm that my child s health is good and that my child is fit to participate in any activities related to the use of the pool at either Hinsdale Central High School or at Hinsdale South High School. I also affirm that my child does not suffer from, and is not under the care of a doctor, for any condition that would prevent or limit his/her participation in the use of the pool at either Hinsdale Central High School or at Hinsdale South High School and that I am responsible for consulting my child s physician before he/she may use the pool at either Hinsdale Central High School or at Hinsdale South High School if it may aggravate any condition that my child may have. I understand that by using the pool at either Hinsdale Central High School or at Hinsdale South High School, my child assumes the risk of injury, allergic reaction, property damage, loss, and/or death, including relating to the depth of the pools. Further, I acknowledge and understand that, by allowing my child to participate, I knowingly and voluntarily assume all risks associated with his/her use of the pools. Release of Liability and Hold Harmless Agreement As a parent/guardian of [insert name of student], I recognize and acknowledge that there are certain risks of injury, allergic reaction, property damage, loss, and/or death that may arise from my child s use the pool at either Hinsdale Central High School or at Hinsdale South High School. I, and my agents, representatives, assigns, heirs and successors hereby waive, relinquish and hold harmless, Hinsdale Township High School District No. 86, its individual Board members, officers, administrators, employees, agents, representatives, volunteers, insurers, assigns and successors, and each and every one of them, from and against any and all claims, demands, suits, liability and causes of actions, whether known or unknown, past, present or future, including, but not limited to, any and all costs, expenses, and attorneys fees, by reason of injury, allergic reaction, loss, or death, arising out of, in connection with, or in any manner related to my child s use of the pool at either Hinsdale Central High School or at Hinsdale South High School, including, but not limited to, injury related to the depth of either pool. I have carefully read this Pool Use Waiver and fully understand its contents. I am aware that by signing this document, I am waiving my right to sue Hinsdale Township High School District No. 86, its individual Board members, officers, administrators, employees, agents, representatives, volunteers, insurers, assigns and successors, and each and every one of them. This Release is complete and signed of my own free will. I am aware that this Pool Use Waiver is a contract between myself, my child(ren), and Hinsdale Township High School District No. 86. I further certify that I have the legal authority to sign on behalf of my child(ren) and family. Name of Student Signature of Student Name of Parent/Guardian Signature of Parent/Guardian Date Relationship to Student _1

4 Request for Records Under the Illinois Freedom of Information Act Date and Time Request Received: oc.,t-o\ne ~ 3 \ (): ~Q 20 \ "1- amd pm~ ALL REQUESTS FOR INFORMATION SHOULD BE DIRECTED TO A DISTRICT FOIA OFFICER: Phone (630) FO IA-Officer@hinsdale86.org Written Request for Records Name of Individual Requesting Records E!J /t/ g J4.,[2 {)I./ A LJJ Organization: S=- -= ='---=L=--> Address Phone: 1 Fax: ---~~~~ Description of Records Requested: /. {) /4,v1.t... C A,o y a F w ;.; Do you want to inspect the requested records? Do you want copies of the requested records? Do you want an electronic copy of the requested records? YES NO ~

5 Requests for a Commercial Purpose Is the request for a commercial purpose? _._O_.,yes RJ no The Illinois Freedom of Information Act defines "commercial purpose" as "the use of any part of a public record or records, or information derived from public records, in any form for sale, resale, or solicitation or advertisement for sales or services. For purposes of this definition, requests made by news media and non-profit, scientific, or academic organizations shall not be considered to be made for a "commercial purpose" when the principal purpose of the request is (i) to access and disseminate information concerning news and current or passing events, (ii) for articles of opinion or features of interest to the public, or (iii) for the purpose of academic, scientific, or public research or education. Section 3.1 states: "It is a violation of this Act for a person to knowingly obtain a public record for a commercial purpose without disclosing that it is for a commercial purpose, if requested to do so by the public body." STAFF INSTRUCTIONS: I.If this request was received in another written for~a c the re ues. to this completed form. 3.Who completed this form? District employee FOIA submitter!kj 4.Submit to FOIA Officer on date of receipt. To be completed by District FOIA Officer Date Form received by a FOIA Officer: OC \-o\oe.~ 3\ 1 '20 \ t Form received by: \")c,\a\:j1 Z ~ \(D vj S l-< l November Deadline for response: Log #17-77 ownship High School Distn t 86 Freedom oflnformation Officer