Special Needs Buddy Application
Our church and kids ministry workers respect your family's right to privacy. Any information shared from this form is communicated directly with those caring for your child and only on a "need to know" basis.
Date of birth
leaves classroom without permission
is easily distracted
has difficulty following directions
has difficulty sharing or taking turns
has separation anxiety
is overly shy/withdrawn
is non-verbal or has speech delays
is overly sensitive to light, touch or sound, etc.
has bathroom or toilet related issues
has difficulty with change and routine
has tantrums/melt downs
displays aggressive behavior to self
displays aggressive behavior to others
has poor fine motor skills (cutting/gluing/writing)
has poor gross motor skills(sitting up/walking)
When your child is upset, what's the best way to communicate with him/her?
What are things that may trigger your child?
What calms your child during a melt down/tantrum?
When your child becomes excited, anxious or frustrated, what does he/she do?
What are some activities and motivation factors that your child responds to and enjoys?
Do you foresee any challenges with your child's participation in church activities? If so, what?
Would you like your child to participate in our Buddy System?
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