Residential trip form Step 1 of 2 50% Trip detailsTrip/visit to:(Required)Please selectBosch EngineeringDisneyland Paris (Euro Disney)Learner 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)Physical and MedicalDoes 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?(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 Please provide information such as: - Dosage and frequency of each medication - Specific times or conditions under which the medication must be administered - Any special instructions for administering the medication (e.g., with food, without food, with a specific amount of water) - Can your son/daughter self-administer their medication, or will they need assistance? Please provide details of the medication needed to be taken on the trip(Required)Details of any medical treatment needed during the trip or medication(s) that need to accompany the participant (e.g. hay fever remedies). If regular medication is needed please ensure that enough is provided to last throughout 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 or asthma 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)ConsentAs the person with parental responsibility, I: - Give my consent for the participant named in Section A to go on this trip. - Agree to the participant receiving medication as instructed and any emergency dental, medical or surgical treatment, including anaesthetic or blood transfusion, as considered necessary by the medical authorities. - Give permission for the participant to receive, if necessary, the following proprietary medications, at a dose appropriate to their age, as follows: - Colds causing congestion - decongestant lozenge - Headache - Paracetamol - Insect bites/stings - proprietary spray or cream - Plant stings - proprietary spray or cream - Sore lips - lip salve or Vaseline - Sun protection - sunscreen - Acknowledge the need for the participant to behave responsibly during the trip. A Behaviour Contract has been completed and signed by the learner and Parent/Carer. - Understand that in the event of serious misbehaviour before the activity, the academy may refuse to take the participant on the trip. In the event of serious misbehaviour during the trip, the academy has the right to exclude the participant from the remaining part of this trip. In either case, the Group Leader’s decision will be final. - Understand that any photographs or video film taken during the trip must be solely for my family’s use and must not be distributed more widely. Photographs may also be taken for publicity use by the academy. - I declare that I have answered all the questions to the best of my ability, have not knowingly withheld any information regarding physical fitness and undertake to inform the trip Leader of any changes between the date signed and the start of the trip. 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 trip.(Required) I consent I understand that:(Required) the £205 payment is a non-refundable 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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