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Special Needs Welcome Application

Hi and welcome! Here at Preston Trail we are passionate about welcoming ALL children into our ministry family. We desire to encourage your child on his or her faith journey while supporting his or her specific needs in a loving, safe, and engaging environment. Every child is different, so we will partner with you to create an individualized plan that leads to your child's success each Sunday. We look forward to meeting you and getting to know your child.

***PLEASE READ***: Please enter your CHILD’s name in the space marked “Your name.” Enter parents/guardians under “Household members.” Thank you!

Your name *

Last name

Email address *

Phone number *

Phone type

Address *

Country

Street address

Apt/unit/box (optional)

City

State

Postal code

Birthday *

Gender *

Grade

School

Household members

Primary Parent or Guardian

Child's Primary Diagnosis *

Child's Secondary Diagnosis

Has your child been hospitalized or treated in an emergency room recently? *

Are there any past injuries, hospitalizations or physical conditions which should restrict activity? *

Care Needs

Please provide some detail about the care needed for your child.

Vision *

Hearing *

Speech *

Mode of communication *

Assistive Devices Used: *

Does your child understand what is being said to him or her? *

Mobility *

Adaptive Devices

AFOs

Helmet

Prosthesis

Other

Bathroom visits *

I understand that the Special Needs team is not equipped to change diapers for children older than 3 years old. *

Do you give permission for special needs volunteers to take your child to the restroom if needed? *

List any known allergies: *

Classroom & Behavior

Please provide information on how your child handles a classroom environment.

Classroom Situation *

Please describe your child's current school or preschool situation.

Adapts to new situations or environments: *

Responds to correction: *

Methods of correction used at home: *

Cool-off time, removal of privileges, etc.

Any specific behavioral challenges? *

Ex. Runs away, bites, self-injury, etc.

Any specific triggers for these behaviors? *

Successful ways to deal with these behaviors: *

What is your child's favorite playtime activity or interests? *

How is he/she best comforted? *

May your child have Goldfish crackers? *

Yes

Do you want to bring a snack from home for your child to have? *

Yes

I would like special needs services during *

Thank you for sharing info about your child!

We’re excited to meet and welcome him/her! We love surrounding kids with a loving, supportive community so they can experience and learn the love of Jesus!

In order to serve as many families with special needs as possible each weekend, we have a simple RSVP process. You’ll simply click a button in a weekly email to let us know if your child will be at church on Sunday.

By checking each box you are indicating your agreement to these statements: *

I will do my best to communicate thoroughly with the Special Needs team regarding attendance and assistance with my child.

I am aware that I am committing to one service time each week. If I need to change it, I will communicate with the Special Needs team.

I am committed to partnering with Preston Trail's Special Needs team.

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Preston Trail Community Church
info@prestontrail.org
972-668-1244