MZConnect Child Registration

MZConnect Child Registration

Please complete this form to help us connect with and support your child at MZKids. Your detailed responses will enable us to provide the best possible experience.
Child's Legal First and Last Name

First NameLast Name
Child's Preferred Name (name child responds to)
Child's Gender
Child's Date of Birth

MonthDayYear
Date
Grade
Type of classroom at school
Child's Diagnosis
Other Health Concerns (i.e. impaired vision/hearing, transportation concerns, seizures, etc.)
Parent/Guardian 1 First and Last Name

First NameLast Name
Parent/Guardian 1 Cell Phone
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Guardian 2 First and Last Name

First NameLast Name
Parent/Guardian 2 Cell Phone
Please enter a valid phone number.Format: (000) 000-0000.
Custody concerns
Primary Contact Name (while child is checked in at MZKids)
Primary Contact Cell Phone
Please enter a valid phone number.Format: (000) 000-0000.
Child's Interests
Other Interests
Activities requiring assistance
Headphones for Managing Loud Noises
Other Assistance Needs
How does your child communicate?
Other Communication Method
How well does your child understand instructions?
How well does your child respond to new situations?
Challenging Behaviors
Other Challenging Behaviors
If your child is having a difficult time, at what point would you like us to contact you?
Toileting Skills
Special Toileting Instructions
If your child is 5 and under, may staff/volunteers assist with changing diapers and pull-ups?
Child's special interests / favorite things to talk about
Signs of enjoyment (vocalizations or other actions)
Signs of frustration or unhappiness and specific triggers (vocalizations, specific phrases, rocking, hand flapping, or other physical movements)
What calms or comforts your child?
What positively motivates your child?
Behaviors that communicate a specific need (ex - signing the letter “T” when child needs to use the toilet, etc.)
Classroom behaviors you would like to be notified of
Brag on your child - tell us what makes you smile when you think of your child
Anything else you’d like to add
How can we partner with you and your family as you work together to grow in Christ?
What Spiritual goals do you have for your child?
Spiritual Goals - Scripture memory
Spiritual Goals - Prayer
Spiritual Goals - Social/behavior
Spiritual Goals - Music time
Spiritual Goals - Lesson time
Parent/Guardian Name (serves as signature)
Date

MonthDayYear
Date
Should be Empty: