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I’m New
Get Connected
Adults
CC Teens
CC Kids
Special Needs
Membership
Bible Study Groups
Lifeshare
Volunteer
Events
Store
Watch
Give
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special Needs new child questionnaire
Let us make your child’s experience the best it can be.
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Child's Name
*
Parent's Email
*
Parent's Name
*
Parent's Phone
*
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Emergency Contact
*
Emergency Contact Phone
*
My child's diagnosis/medical condition/learning difference
*
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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
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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
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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
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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
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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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