Residential trip form - The JCB Academy

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Trip details

Trip/visit to:(Required)

Learner details

Name(Required)

First Last

Address(Required)

Town/City(Required)

Postcode(Required)

Year group(Required)

Year 9

Year 10

Year 11

Year 12

Year 13

Medical details

Name of doctor(Required)

Doctor's address(Required)

Doctor's Town/City(Required)

Does the learner have any condition that may restrict, or be aggravated by physical activities?(Required)

Yes

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

Please provide details of the medical requirements(Required)

Will the learner need to bring any medication(s) for treatment during the trip?(Required)

Yes

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

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)

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).

Bed-wetting (please note, the person with parental responsibility will need to provide suitable bedding).

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

Please provide details of the dietary requirements(Required)

Parent/carer details

This form needs to be completed by a person with parental responsibility for the above child.

Name(Required)

First Last

Telephone

Consent

As 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.

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Harper trip

As 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 the £280 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

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Spain trip

I 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

COVID Vaccination

Currently, there is no requirement for vaccination before entry Spain. However, if the COVID guidelines do change and learners are required to be vaccinated, it is important you understand that it will be your responsibility to ensure your son/daughter is vaccinated. If you were unwilling to do this, your son/daughter would be unable to travel; the insurance company would consider this to be a disinclination to travel meaning they would not cover the cost of withdrawal and you would be liable for the full trip cost.

I have read the COVID vaccination disclaimer and(Required)

I understand the above and that if I decide to pull my son/daughter out of the trip at any point, the deposit and the monthly instalment will not be refunded and the remaining balance will only be issued if a replacement is found.

Bosch Engineering

Pick 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

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All trips

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