Kingdom Kidz "Unlimited" - Special Needs Questionnaire
We want to get to know your child better and make his/her experience in the life of the church the best it can be. We ask that you fill out this form so we can better serve you and your child. Any information you provide will be helpful in serving you and your child. This will be used by children and youth ministry leaders and shared on a ‘need to know” basis, keeping it confidential
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Child's Name *
Child's Age *
Child's Date of Birth: *
Child's Grade: *
Father's Name: *
Father's Cell Phone #: *
Father's Email:
Mother's Name: *
Mother's Cell Phone #: *
Mother's Email: *
Your Name: *
What are special interest and motivating factors your child responds to or enjoys? *
Does your child prefer to work with a teen or adult? *
List confirmed special needs/disabilities: *
Please check any that are applicable to your child that our teachers/buddies will find helpful to minister to your child: *
If you selected Allergies above, please tell us about your child's allergies: *
Do you foresee any challenges with your child participating in church programs?  If so, what? *
What are some suggestions on how to best handle situations/discipline? *
Any concerns you would like to share about your child? *
Are there steps you want us to follow in case of a medical emergency?  If so, please list: *
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