UNlimited Kids

Name

Parent/Guardian Name

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Phone

Address

Child's DOB

Grade

We believe that every child deserves a place to belong with people who believe in them. To include every child, Crossroads Baptist Church UNlimited Ministry supplies assistance to those children (persons) who may need a little extra help during church services. These questions are asked so that we may provide the best experience and safest environment possible. Crossroads Baptist Church UNlimited Ministry respects your right to privacy. Any information shared from this form is communicated directly with those caring for your child. Please answer the following questions that apply to help us best serve your family.

My child has the following learning difference, diagnosis, or medical condition:

My child needs assistance with (e.g. using the restroom, reading, writing):

My child may become frustrated or be uncomfortable with (e.g. loud noises, lights, physical touch):

When/if my child experiences frustration, he/she can calm down by:

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UNlimited Kids

Description

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