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Keystone Friends: Special Needs Ministry Registration
Keystone Friends is our Special Needs Ministry at Keystone Church. This form helps us know who our Friends are and how we can best serve them during their time here on Sunday mornings.
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* Indicates required question
Child/Student Name
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Your answer
Child/Student's Age & Birthdate:
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Your answer
School/Grade:
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Your answer
Parent(s) or Guardian(s):
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Your answer
Parent(s) Cell Phone Number & Email:
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Your answer
Home Address:
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Your answer
Emergency Contact Person & Phone Number:
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Your answer
Person(s) able to pick up child/student after service:
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Your answer
Child/Student's Special Need(s):
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Your answer
Medical Precautions/Conditions:
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Your answer
Any specific safety precautions we should be aware of:
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Your answer
Allergies:
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Your answer
Favorite Color:
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Your answer
Favorite Toys/Activities:
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Your answer
Things that make them happy:
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Your answer
Things they like to talk about:
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Your answer
Things they don't like to talk about or that make them sad:
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Your answer
Comfort Items:
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Your answer
How they communicate:
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Sign language
Gestures
Pictures
Words
Other:
Required
Family Info: How many siblings? What are their names?
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Your answer
Family Info: Other special family members & friends - names/relationships?
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Your answer
Family Info: Pets at home-type and names?
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Your answer
Does your child/student need any assistance for safe mobility? (Ex: stand by assistance, physical assistance, assistive devices, etc.)
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Your answer
Restroom: Independent or Dependent? Any assistance needed with clothing and fasteners?
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Your answer
Are there any environment factors that may bother your child/student?
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Your answer
Do you have any tips on ways to achieve the best focus and response when working with your child/student?
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Your answer
Please share anything else about your child/student you feel is important for us to know:
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Your answer
Would you be comfortable with a teen volunteer as a buddy for your child?
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Yes
No
Other:
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