Please complete this form to register your child for our Special Needs Vacation Bible School.  You may complete the form here on our site and then click the submit button to email it to us.  If you prefer you may print the form and return it to the church office by May 31.

Special Needs Vacation Bible School Registration Form
Child Name
Birthday
Parent 1 Name
Parent 2 Name
Address
Telephone
Sibling Names and Ages
email
Emergency Name
Emergency Phone
Dismissal Information
Who may pick up your child
School
Type of Placement
Current Medications
Does your child have seizures
Describe behavior
Sensory Processing Issues
control behavior
people he or she does not know
Food allergies - describe
Food restrictions
toileting needs
feed him or herself
Physical Needs
speech understandable
communicate basic needs
sign lang or lang board
special care needs
currently enrolled in church
previous experience in church
permission to photograph