Respite Registration at New Life Community Church
Please fill out the information below so we can best meet the needs of your child. Thank you.
Email questions to
Events begin at 6pm. Pick up is at 8pm
Doors open at 5:45pm
Name of child/adult:
Name of parents/guardians/caregivers:
Alternate Emergency contact (name & phone #):
Aside from parents, what other person(s) is authorized to pick up your child? (must be 18 yrs. or older)
These things might upset them:
What is their diagnosis?
What strategies can we use to help calm your child if he/she is upset?
Any other additional information you would like to provide our volunteers?
Medications, dietary restrictions, toiletling instructions, etc.
I give New Life Community Church permission to take a picture of my child for the New Life Community Church database and/or for publication purposes.
Yes, for database only
Yes, for database and publications (websites, flyers, etc.)
I give New Life Community Church permission to take any necessary actions to ensure the safety of my child.
Taking any medical or physical precautions or calling authorites for an emergency
If your child has a severe food allergy, please bring a snack with him/her and check it in at the registration table.
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