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Plan a Visit
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Leadership & Staff
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Request a Special Needs Buddy
Please fill out the form below and someone will be in contact soon.
Parent/Guardian First Name
Parent/Guardian Last Name
Kid's First Name
Date of Birth
Kid's Last Name
My kid has the following diagnosis, medical condition(s), or learning difference
What are some interests and motivating factors your kid responds to or enjoys?
Do you forsee any challenges with your kid participating in church programs? If so, what?
Please check any that apply
Short Attention Span/ Easily Distraced
Fine Motor Skills (Cutting/Pasting)
Gross Motor Skills ( Walking/Jumping)
Leaves Classroom Without Permission
Trouble with Sensory Experiences
Aversion to Water, Light, Mask, etc.
Trouble w/ Following Directions
Difficulty Interacting with Peers
Difficulty w/ Changes in Routine
Difficulty Remaining on Task
Difficulty Sitting in a Group
Tends to be Possessive
Difficulty in Social Settings
Choose an option
Are there any other concerns you would like to share?
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