Understand Me Better | Community:Kids
Please tell us more about your special needs child by filling out this form. This will help us to best support your child. After we review your form, we will contact you to discuss further.
Email address *
Child Information
Child Full Name: *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Grade: *
Your answer
Family Information
Mother's Name: *
Your answer
Father's Name: *
Your answer
Siblings:
Your answer
Custody Concerns: *
Your answer
Emergency Contact Information:
Household Address:
Your answer
Home Phone with area code:
Your answer
Cell Phone(s):
Your answer
Email: *
Your answer
Contact Preference: *
Your answer
Please contact me when:
Your answer
Understanding your Child
Tell us about your child's strengths (Go ahead . . . Brag!): *
Your answer
Please list your child's interests (this helps us form relationships): *
Your answer
Medical Needs
Please tell us about any health and medical needs that would allow us to best support your child and keep him/her safe:
My child has:
Please explain any of the above or provide us with any additional information that would make you feel comfortable as we work with your child:
Your answer
Please select any tasks that your child requires help with: *
Required
Help us understand by completing phrases or describing a bit more:
When my child gets upset, he/she will: *
Your answer
The best way to calm my child is to: *
Your answer
If my child needs the restroom, he/she will communicate by: *
Your answer
My child needs some prompting to maintain attention or take turns. The best things to do are: *
Your answer
I know my child needs a break when: *
Your answer
Other information (avoidances, medical considerations, communication needs, intense focus area, etc. *
Your answer
How can we partner with you and your family as you work together to grow in Christ? *
Your answer
What do you want your child to get out of our Special Needs Ministry? *
Your answer
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service