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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 Child QUESTIONNAIRE
let us make your child’s experience the best it can be.
Child's Name
Parent's Name
Parent's Email
Parent's Phone
Emergency Contact
Emergency Contact Phone
My child’s diagnosis/medical condition/learning difference
My child's learning style
auditory
visual
tactile
read/write
My child's main mode of communication
verbal
sign language
speech device
other (please specify)
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
If yes, what are his/her specific allergies?
My child may have the snacks provided in class
yes
no (my child will bring his own snacks to class)
Areas my child receives therapy
Areas my child needs assistance
Additional comments/information about my child
I am 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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Missions
Church Family
Contact Us
