Caring for FCC Kids with Exceptionalities
These questions allow us to provide the best experience and safest environment for all of our friends within the ministry. Our church leaders and ministry volunteers will respect your family’s right to privacy. Any information shared is communicated directly with those caring for your family member and only on a “need to know” basis. If you have any questions, please contact Pastor Haleigh for more information.
Child's Name:
*
First Name
Last Name
Birth Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Parent Name
*
First Name
Last Name
Parent Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Parent Email
*
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Does your child have a diagnosis?
*
Please list all Medical Details such as allergies/food sensitivities, whether they carry an epipen or not, history of seizures and/or behavioural concerns:
My Child loves to:
My Child enjoys
arts and crafts
music
outside play
writing
reading
Other
Toileting needs:
*
independent
with assistance
wears diapers
Other
Main form of communication:
*
Verbal
Visual supports
sign language
digital devices
Other
My child needs assistance with:
My child is uncomfortable with or has sensitivities to:
Behavior concerns to be aware of:
Calming tools and aids:
Goals for your child at church:
*
Ideas for the church to better serve your family:
*
Additional thoughts or comments:
Submit
Should be Empty: