Church Leader: JP Participant Roster

JP Participant Roster

The Youth Leader needs to fill out this form for EVERY participant coming to your JP work camp!
Week attending the Jeremiah Project:*
Name (needs to match name on student's medical form)*

First NameLast Name
Preferred Nickname
Church Name*
Spelled out, no abbreviations
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Parent/Adult Email Address:
example@example.com
What grade will he/she have completed in June 2026?*

5th grade6th grade7th grade8th grade9th grade10th grade11th grade12th gradeAdult Leader
Birth Sex*

MaleFemale
Dietary, Medical or Allergies Concerns? Please explain:
Other notes or important information:
Help us better serve your students by informing us of any emotional or behavioral concerns ahead of time. We will also work with you one on one to ensure we are equipped to work with, serve, and care for your students while they are with us at JP!
Should be Empty: