JBA Jr. Student Registration 2025 - Form Builder

Confirmation Email Address*

Student First Name*

Student Last Name*

Student's Street Address*

Student's City, State, and Zip Code*

Grade completing at the end of this school year.*

4th grade

5th grade

6th grade

Homeschool

Student's Date of Birth*

School Name and District (or homeschool)*

Parent/Guardian #1 Name (First and Last)*

Parent/Guardian #1 - Address (if different than student)

Parent/Guardian #1 - Email Address*

Parent/Guardian #1 - Cell Phone*

Parent/Guardian #2 Name (First and Last)

Parent/Guardian #2 - Address (if different than student)

Parent/Guardian #2 - Email Address

Parent/Guardian #2 - Cell Phone

Student attended JBA, Jr. in *

2023

2024

Have not attended before

Please provide specific information about student allergies or other pertinent medical information.

Emergency Contact First and Last Name

(In case parent(s)/guardian(s) cannot be reached)*

Emergency Contact Phone Number*

Student's T-Shirt Size*

Please provide any information that will help us best serve your child.

I understand and acknowledge that submission of this form also requires payment for attendance at JBA, Jr. no later than July 7, 2025. The payment amount is based upon my students free/reduced lunch status at school. *

Yes

I understand that submission of this registration provides consent for photography/videography and transportation of student for Academy activities (such as to/from the Truman Farm) unless notification is received in writing prior to attendance at JBA, Jr. emailed to jba@truman.edu.*

Yes