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
Child's Name *
Your answer
Child's Age *
Your answer
Child's Date of Birth: *
MM
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DD
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YYYY
Child's Grade: *
Your answer
Father's Name: *
Your answer
Father's Cell Phone #: *
Your answer
Father's Email:
Your answer
Mother's Name: *
Your answer
Mother's Cell Phone #: *
Your answer
Mother's Email: *
Your answer
Your Name: *
Your answer
What are special interest and motivating factors your child responds to or enjoys? *
Your answer
Does your child prefer to work with a teen or adult? *
List confirmed special needs/disabilities: *
Your answer
Please check any that are applicable to your child that our teachers/buddies will find helpful to minister to your child: *
Required
If you selected Allergies above, please tell us about your child's allergies: *
Your answer
Do you foresee any challenges with your child participating in church programs? If so, what? *
Your answer
What are some suggestions on how to best handle situations/discipline? *
Your answer
Any concerns you would like to share about your child? *
Your answer
Are there steps you want us to follow in case of a medical emergency? If so, please list: *
Your answer
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