Child Intake Form
It is our goal at Heritage CRC to meet the needs of all of our children, so that all experience full belonging to the body of Christ and spiritual growth toward Christ.  We want to partner with you as parents and value the input you have to share about your children!

This information will be securely stored in an online document and only released as needed/appropriate to adults working directly with your child.  If you have any concerns about the security/release of the information, please contact the church office.

Please fill out this form individually for each of your children.  Thank you!
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Name of person filling out form
Relationship to Child
Phone number
Email
Name of Child
Grade of child
Emergency Contact
Please list names of all people who your child can be released to at the end of an event/program:
Program(s) entering
What are some things your child enjoys?  Things he/she is good at?
Are there any factors that may affect your child’s participation in church programs?
Is there anything else that would be helpful for us to know about your child?
Are there any specific things Heritage could do to support your child?
Would you like a member of the ADA Team (Advocates for Disability and Aging) to contact you regarding additional supports, accommodations, collaborating to support participation, etc.?
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