First Bible Church - Special Needs Intake Form

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Intake Form for Children with Special Needs

Details About Your Child
Thank you for helping us be prepared to welcome your child, keep him/her safe, and set everyone up for success in Children's Ministry at First Bible Church.

Child's First Name

Child's Last Name

Which service do you plan to attend?
9:15
10:45

My child really enjoys...

What could potentially upset your child?

Please list any sensory processing needs. (i.e. does not like to be touched, music overstimulates, etc) Does your child have any equipment to mitigate? (i.e. headphones).

Please list any unique communication needs. (limited speech or non-verbal, use of visual schedules, difficulty reading facial expressions, etc.)

Please list any behaviors your child exhibits that might be harmful to themselves or others.

The best way to calm my child is...

What motivations/rewards typically help your child?

What strategies work for you when helping your child?

Does your child have a tendency to run out of rooms?
Yes, my child will likely run out the open doors of a classroom.
No, my child does not typically exhibit that behavior.
My child might run out, might not.
Other (please list below)

If You Selected Other:

Toileting Needs: (Note: Children preschool aged and older will require a parent to change diapers/accidents.)
My child is completely independent in the bathroom.
My child needs assistance using the bathroom.
My child wears pull ups/diapers.
Other (please list below)

If You Selected Other:

Any additional thoughts or comments to help us as we care for your child?

For additional children, please submit another form.

Submit

About

The mission of First Bible Church is to glorify God by helping people know, love, obey, and exalt Jesus Christ.

News & Events

Service Times

Sunday Mornings
9:15am & 10:45am

Contact Info

256-353-2711 - Decatur
3202 Spring Avenue, Decatur, AL 35603
256-306-6100 - Madison
29113 Huntsville Brownsferry Rd.,
Madison, AL 35756

Intake Form for Children with Special Needs

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