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Special Needs Preschool Ministry
Please fill out this form if you have a special needs child in need of care during Life Groups and/or church service. Laura Tucker, our Special Needs Preschool Director, will contact you shortly.
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* Indicates required question
Email
*
Your email
Child's first and last name:
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Your answer
Child's age:
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Your answer
Parent(s)/guardian(s) first and last names:
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Your answer
Parent(s)/guardian(s) phone number:
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Your answer
Is your child in school?
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Yes
No
If he/she is in school, which grade is he/she currently in?
Your answer
Special needs diagnosis:
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Your answer
Does your child have any special dietary needs or other feeding concerns? (For example: lactose intolerant, peanut allergy, red dye, difficulty chewing/swallowing, etc.)
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Your answer
Is your child currently taking any medications?
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Your answer
Is your child potty trained?
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Yes
No
Tell us a little bit about your child... What does he/she like and dislike?
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Your answer
How do you console your child once he/she becomes upset?
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Your answer
Are there any behavior concerns? If so, what do you do at home to correct the behavior?
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Your answer
Which service would you prefer to attend or which service are you currently attending? Check as many as apply to you.
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9am Sunday Church Service ONLY
10:30am Sunday Church Service ONLY
Sunday Life Groups at 9am and 10:30am Church Service
Sunday 9am Church Service and 10:30am Life Groups
Wednesday night service
Sunday night service
Required
Is there anything else you would like to share about your child?
*
Your answer
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