Spring Hills Kids | Special Needs Ministry Registration
Thank you for your interest in the Spring Hills Kids Special Needs Ministry. This form helps our team learn about your child so we can create a safe, supportive environment where they can learn about Jesus and feel they belong.
Family Information
Parent/ Guardian Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Best way to contact you:
*
Phone
Text
Email
Child's Name
Child's Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Grade
*
Does your child have a formal diagnosis?
*
Autism Spectrum Disorder
ADHD
Down Syndrome
Sensory Processing Disorder
Speech / Communication Delay
Anxiety
Other
Communication
How does your child primarily communicate?
*
Verbal
Limited Verbal
Non-verbal
Communication device
Sign Language
Other
Does your child follow verbal directions?
*
Easily
Sometimes
Needs visual support
Needs one-on-one assistance
Support Needs
What situations are most challenging for your child? (check all that apply)
*
Loud noises
Transitions between activities
Large groups
Waiting
Changes in routine
Physical contact
Other
Helpful Supports
What strategies help your child succeed?
*
Visual schedules
Sensory tools
Movement breaks
One-on-one support
Quiet space
Clear routine
Other
Safety Information
Are there behaviors we should be aware of to keep your child and others safe?
*
If your child becomes upset, what helps calm them?
*
Ministry Participation
Which environment would best support your child?
*
Inclusion Classroom (with a buddy if needed)
Self-Contained Special Needs Classroom
Unsure — would like guidance
Additional Information
Is there anything else you would like us to know about your child so we can help them have a great experience?
*
Submit
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