Residential trip form Step 1 of 2 50% FacebookThis field is for validation purposes and should be left unchanged.Trip detailsTrip/visit to:(Required)Please selectHarper AdamsCCF Swynnerton - 2 Oct 2025Learner detailsLearner Name(Required) First Last The above learner has(Required) recently finished Y9 at the academy recently finished Y9 at another school & is joining the academy in September Year group(Required) Year 9 Year 10 Year 11 Year 12 Year 13 Medical detailsName of your GP(Required)Doctor's address line 1(Required)Doctor's Town/City(Required)MedicalParacetamol Consent In the event that your son/daughter experiences mild to moderate pain (e.g. headache or period pain) or develops a raised temperature during the trip, staff may need to administer paracetamol. Please indicate your consent for paracetamol below(Required) Yes, I give permission for my son/daughter to be given age-appropriate doses of paracetamol by a designated member of staff if required during the residential visit. No, I do not give permission for my son/daughter to be given paracetamol during the residential visit. Does the learner have any condition that may restrict, or be aggravated by physical activities?(Required) Yes No Please provide details of the physical activity related condition(Required)Any condition(s) causing restriction upon, or that may be aggravated by, physical activities and relevant details (confirmation of fitness to participate, from a doctor, may be required in certain cases).Does the learner have any medical conditions that may or may not require medication?(Required) Yes No Please provide details of the medical requirements(Required)Will the learner need to bring any medication(s) for treatment during the trip?(Required) Yes No MedicationPlease list any prescription or non-prescription medications your child will require during the trip. This includes any regular medication, as well as any medication that may be taken "as needed" (e.g. antihistamines, asthma inhalers).Medication(Required)Please click the '+' symbol to add more itemsMedication NameDosage (e.g. 10mg)Number of times per dayTime(s) to be administered Add RemoveMedication Labelling and Storage Requirements All prescription medications sent with your son/daughter must be: In date In the original packaging Clearly labelled by the pharmacy with your child’s name, the medication name, and the dosage instructions. As the parent/carer(Required) I will ensure any prescription medication provided meets the above requirements I understand that if medication is not correctly labelled or is out of date, it cannot be accepted or administered during the trip Has the learner suffered from, or been in contact with anyone suffering from, an infections or contagious disease in the last four weeks?(Required) Yes No Please provide details of infections or contagious disease(Required)Provide details of infectious/contagious disease the learner has suffered from or been in contact with during the past four weeks.Does the learner suffer from?(Required) None of the below Epilepsy Diabetes Asthma Bedwetting Allergies (including to any medication) Bed-wetting (please note, the person with parental responsibility will need to provide suitable bedding).Does the learner suffer from?(Required) None of the below Epilepsy Diabetes Asthma Allergies (including to any medication) Please provide details of the epilepsy, diabetes, asthma or allergies condition(Required)Please include severity and frequency of attack, approximate date of the last attack and details of any medication taken regularly or kept for emergencies. (Confirmation of fitness to attend, from a doctor, may be required before affected participants are deemed suitable to participate in some trips).Please provide details of the allergies(Required)Provide details of allergies, including reaction to painkillers, antibiotics, analgesic, other propriety medicines and food.Does the participant have any dietary needs?(Required) Yes No Please provide details of the dietary requirements(Required) Parent/carer detailsThis form needs to be completed by a person with parental responsibility for the above child.Parent/Carer Name(Required) DrMissMrMrsMsProf.Rev. Prefix Last Email(Required) Enter Email Confirm Email Telephone(Required)ConsentLearner Agreement I understand that while on the trip, I must abide by the expectations/rules set out below, act responsibly and follow briefings and instructions given by staff. I understand that any failure to abide by the conditions of participation while on the trip may result in disciplinary action being taken on the trip and, in more serious cases, on return to school. I understand that in the most serious of cases, I will be immediately sent home. Parent Agreement I have read, understand and agree with the points above and agree to discuss this agreement and the behaviour expectations with my son/daughter. Whilst on the trip, The JCB Academy expects: Learners to follow the directions and guidance of any member of staff. Academy property, accommodation property or the property of another person to be respected. Learners to be polite and not use foul or inappropriate language. The JCB Academy will not accept the following behaviour: Verbal assaults on staff or other learners. Physical assaults on staff or other learners. Substance abuse. Racially motivated incidents. Homophobic or other discriminatory behaviour/language. Behaviour which is against the criminal law. Bullying, which includes cyber-bullying. Intimidation. Possession or misuse of drugs*. Supplying drugs and the possession of drugs with a view to supplying others. Possession of knives or other offensive weapons. Behaviour that is likely to bring the academy into disrepute. * Drugs are defined as those that are legal (such as alcohol, tobacco and solvents, legal 'highs', over-the-counter performance enhancing drugs, prescribed drugs, vape oils) and illegal drugs. Please note that this list is not exhaustive.This field is hidden when viewing the formStandon BowersAs the person with parental responsibility I agree with the above agreement and hereby give my consent for my son/daughter to go on the trip.(Required) I consent This field is hidden when viewing the formHarper tripAs the person with parental responsibility I agree with the above agreement and hereby give my consent for my son/daughter to go on the Harper Adams residential trip.(Required) I consent This field is hidden when viewing the formSpain tripI agree(Required) To pay an initial non-refundable deposit of £400 followed by monthly instalments of £240 in June and July. That the above named child has a valid passport, appropriate visa and an EHIC card. I understand that the £400 deposit is a non-refundable and I will fully adhere to the payment schedules set out in the letter.(Required) I understand the deposit and payment schedules Disneyland ParisPlaces are available on a first-come, first-serve basis through a deposit of £100 on ParentPay.I understand that(Required) I need to pay a deposit of £100 via ParentPay to secure my place Bosch EngineeringPick up(Required) I will pick my son/daughter up from The JCB Academy My son/daughter will make their own way home from The JCB Academy I will pick my son/daughter up from Derby & Burton Services, Willington This field is hidden when viewing the formAll trips We take spam very seriously and any personal information we collect from this website will be used in accordance with the Data Protection Act 2018 and other applicable laws. You can change your mind at any time by clicking the unsubscribe link in the footer of any marketing emails that you may receive from us in the future. 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