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I’m New
Get Connected
Adults
Women 2 Women Ministry
CC Teens
CC Kids
Special Needs
Membership
Bible Study Groups
Lifeshare
Volunteer
Events
Watch
Give
I'M NEW
WATCH
MENU
I’m New
Get Connected
Adults
Women 2 Women Ministry
CC Teens
CC Kids
Special Needs
Membership
Bible Study Groups
Lifeshare
Volunteer
Events
Watch
Give
I’m New
Get Connected
Adults
Women 2 Women Ministry
CC Teens
CC Kids
Special Needs
Membership
Bible Study Groups
Lifeshare
Volunteer
Events
Watch
Give
I'M NEW
WATCH
MENU
special Needs new child questionnaire
Let us make your child’s experience the best it can be.
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Please enable JavaScript in your browser to complete this form.
Child's Name
*
Parent's Name
*
Parent's Email
*
Age of Child
Parent's Phone
*
Emergency Contact
*
Emergency Contact Phone
*
My child's diagnosis/medical condition/learning difference
*
My child's main mode of communication
*
verbal
sign language
speech device
other (please specify)
If other, please specify
My Child's Learning Style
*
auditory
visual
tactile
read/write
My child likes
My child dislikes/is uncomfortable when
My child is pottytrained
*
Yes
No
If no, would you prefer our volunteers to change your child's diaper, or would you rather us contact you to do so?
*
Yes
No
My child is calmed by
If your child is calmed by touch, do you give your permission for our volunteers to do so?
Yes
No
Does your child have any allergies?
*
Yes
No
My child may have the snacks provided in class
*
Yes
No (my child will bring his own snacks to class)
If yes, what are his/her specific allergies?
Areas my child receives therapy
Areas my child needs assistance
Additional comments/information about my child
I'm planning to attend:
*
Sunday Bible Study Groups — 9 A.M
Sunday Morning Worship — 10:15 A.M.
Sunday Evening Worship — 6 P.M.
Wednesday Evening — 7 P.M.
When do you plan to visit?
*
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About Campus Church
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Our Leadership
God’s Free Gift
Missions
Church Family
Store
Contact Us
