Exceptional Needs Intake Form

Central Church cares for each participant in our family ministry. The following questions are asked for your child's benefit, so we may provide the best experience and the safest environment for everyone involved.

All children in our Exceptional Needs program will be assigned a buddy to help them at Central Church. This form helps us understand your child's specific needs and which setting(s) may be most helpful for your child.

Our church leaders and our ministry volunteers respect your family’s right to privacy. Any information shared from this form is communicated directly with those caring for your child and only on a “need to know” basis. Please answer the following questions that apply to your child to help us best serve your child.

*While this form is fillable on a mobile device, it is best completed on a desktop or laptop. 

We understand there may not be a “perfect” answer to the following questions. Please respond to the best of your ability and select the option that most closely fits your child.

To care for your child in the best way possible, we rely on the information you share with us. By signing below, you confirm that your responses are honest and complete to the best of your knowledge.