SPECIAL NEEDS INTAKE FORM

CARING FOR THOSE WITH SPECIAL NEEDS

If you have a child, youth or young adult who needs assistance in order to participate in Sunday morning services or other mid-week ministries, please fill out the form below. We would love to learn more and determine how we might best help your family connect to Jesus and grow to love and serve Him. These questions allow us to provide the best experience and safest environment for your loved one within the ministry. Our church leaders and ministry volunteers will respect your family’s right to privacy. Any information shared is communicated directly with those caring for your family member and only on a “need to know” basis.

CHILD

MOTHER

FATHER

SIBLINGS

HOBBIES


ALLERGIES & MEDICAL







OTHER