"Share Your Story" Form
We are so excited to have you and your children participate in our Belong Ministry! Belong Ministries are ministries and programs at Bethany Community Church that support and connect families of children with special needs, foster families, adoptive families, and any families or children that could use an extra buddy for support. The following questions are intended to help us best care for your kids, to make sure they are happy, healthy, and cared for during their time with us.

Please email Amy Wilkinson at amyw@churchbcc.org for questions. Thank you!
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Email *
Child's name (first & last): *
Child's birthday: *
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Parent/Guardian name(s) (first & last): *
Parent/Guardian email(s): *
Emergency contact name (first & last): *
Emergency contact phone: *
We as a team are so excited to have your child here! What are some things we can do to help them feel loved and welcomed?   *
What are some of your child's favorite activities? *
Please list any medical and educational diagnoses that would be helpful for our team to know *
Please list all medications your child is currently taking, and please take note if any of these medications must be left on site with your child.                                                                         *
Please list any allergies your child has: *
What (if any) triggers cause your child to become frustrated or fearful?      
If there is a trigger, what do your child's behaviors look like?
If your child becomes upset, what are the best coping strategies to help them deescalate?        
What does a successful Sunday morning look like for you and your child?  (skip if you do not attend Bethany on Sunday mornings)
What language or supports can be used proactively (e.g., common verbiage used at home and school, social stories, visuals, etc.)? *
Every child is special, what is something unique about your child that will help us understand and connect with them?           *
Anything else you would like a buddy to your child to know?
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