Ranger's Questionnaire

Rangers Questionnaire

This form is designed to help us best serve your child's unique needs during their time with us in Compass Kids. Note that this form is for children who need a little extra help while they're with us. We will review this information and contact you promptly. Since it is our aim to provide the highest level of care, we may not be able to accommodate every situation due to space or team limitations. Thank you for taking the time to help us make your child feel right at home!
Student Name *

First Name Middle Name Last Name
Birth Date

Month Day Year
Gender *
Parent's E-mail *
example@example.com
Parent's Mobile Number *
Please list any sensitivities we should be aware of. *
Does your child require assistance using the bathroom? *

Yes No
If your child becomes upset, what are some things they would find comforting? (going for a walk, a comfort item, etc.) *
In your opinion, would your child do best in an environment that is age based or developmentally based? *

Developmentally Age
What is your child’s primary method of communication? *

Speaking Gestures PECS board Non-verbal Other/AAC
Has your child been diagnosed with a special need? If so, please describe. *
Would your child enjoy a large group worship experience? If not what is the reason? (Too loud, too much movement, too dark) *
What activities does your child need assistance with? *
I would like to be notified when my child exhibits the following behavior: *
Is there anything else we should know about your child?
Please explain any medical conditions (other than allergies) that we should know about. *
Does your child require a medical device of any kind? If so, please describe. *
Does your child have any behaviors or signs that let us know medical attention will be needed? *
At what point should we contact you or a medical professional? *
List Allergies. Please note if allergies are ingested, contact, or inhaled allergies. *
Are any of these allergies life threatening? *

Yes No
Should be Empty:

Rangers Questionnaire