St. Andrew's SPiES New Participant Form
Special People whose Identity is Eternally Significant
Email address *
Last Name, First Name of Participant *
Your answer
Age of Participant *
Your answer
Last Name, First Name of Registering Parent/Caregiver *
Your answer
Phone Number of Registering Parent/Caregiver *
Your answer
Participant Details
Please describe the participant's needs and diagnosis *
Your answer
How does Participant communicate? *
Required
Participant enjoys: *
Required
Please describe the following for your Participant:
Things that are comforting: *
Your answer
Things that cause distress or that should be avoided: *
Your answer
Favorite toys or activities: *
Your answer
Activities or toys that are disliked: *
Your answer
How do you redirect undesirable behavior? What are key phrases or actions that help? *
Your answer
Toileting Procedures
Does your Participant... *
Additional Information
Describe your Participant's mobility: *
Required
Does the Participant have seizures? *
Does the Participant have allergies? If yes, please describe and include any relevant information about using an Epi-Pen. *
Your answer
What snacks is your Participant allowed to have? *
Your answer
What current goals do you have for your Participant? *
Your answer
Any additional comments or information that we need to know? *
Your answer
SPiES Class Options
We have two primary class options for our SPiES. We maintain a 1-on-1 ratio as much as possible.

The SPiES Specialized Class - our Specialized Class meets in our SPiES Room for worship, Bible teaching, activities, service projects, and prayer, catered to the needs of those in the class.

The Inclusion Group - Inclusion SPiES travel to their grade specific ministry program and participate in worship, Bible teaching, and activities with their typical peers.
Please indicate your preference for your Participant's Class: *
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This form was created inside of St. Andrew's United Methodist Church. Report Abuse - Terms of Service