Dietary/Special Needs for Student or Adult Leader

Dietary/Medical Needs for Student or Adult Leader
Greetings from JP!

With this form, you will have an opportunity to note any dietary concerns, medical needs, etc. You may also include any specific emotional or behavioral concerns that you would like our staff to be aware of. All information is voluntary but dietary concerns are required for meal preparation and planning.

A note on dietary needs: To be the best stewards of time and resources, it is extremely important for the staff to have accurate information on the serious issues our campers deal with. So please do not use this form for preferences or dislikes. Thank you!
Dates attending the Jeremiah Project:
Participant's Name

First NameLast Name
Email
Church Name
Spelled out completely (no abbreviations)
Is this information for a student or adult participant?
Male or Female
Please list any Dietary Concerns such as: food allergies, food intolerances, celiac disease, vegetarian etc.
Please note any medical, emotional or behavorial concerns you may wish for our staff to be aware of:
Should be Empty:

Dietary/Medical Needs for Student or Adult Leader