Unique Needs Registration Form

In order to help us better meet the needs of your child, please enter YOUR name and information first, then add only ONE CHILD WITH UNIQUE NEEDS per registration form and complete the questionnaire for that child. Thank you!

Your name *

Email address *

Privacy Statement & Medical-Related Expectations

Your child's information on this form will be handled with utmost discretion and confidentiality by Unique Needs Ministry leaders and Sandhills Staff.

The Unique Needs Ministry and its volunteers should not provide or be asked to provide medical services that should be provided by a medical professional or the child's caregiver only, with the exception of administering basic first aid or rescue medicine if necessary. This includes: providing or suggesting diagnoses, therapy services, transport, administering non-emergent/routine medicines, adjusting medical devices (e.g. pumps, any type of -ostomy), or hygiene assistance for older children.

**Under "Household members," click "+Add child" for your child with Unique Needs.

*** PLEASE ONLY LIST ONE CHILD PER FORM TO AVOID CONFUSION.***

Household members

Phone number

Please list additional name(s) and phone number(s) of emergency contacts. *

If different from above. At least 1 recommended.
Example: Jane Doe (aunt) - 888-888-8888

Does your child have a diagnosis you would like to share with our team?

Can be any seen or unseen condition that might be relevant to know about at church.

ADD/ADHD

Autism

Learning difference/delay

Post-Traumatic Stress Disorder (PTSD)

Sensory seeking or sensory avoiding

Other (can describe below)

Does your child has any allergies we need to be aware of? *

Is assistance needed with eating/drinking?

**If your student requires modified or different foods, we recommend bringing packed, nut-free foods/drinks from home.

Yes

Certain foods may need to be modified so it is safe to eat. Modified, safe snack options will be brought from home.

Please list any foods/drinks we should not give your child.

Does your child need assistance using the restroom or is in diapers? *

For children elementary ages and up, caregivers will be notified when their child needs to use the restroom or be changed.

List activities your child enjoys most, interests, or favorite things: *

Are there any other specific triggers that cause your child to become anxious, fearful or upset? What helps calm your child down during these times? *

Any suggestions on how we can best accommodate your child during Sunday services and other church events? *

Examples: 101 Buddy to help participate in activities, headphones, wobble cushion, fidget, allow child to bring stuffed animal from home, etc.

Is there any additional information we should know?

For other household children without unique needs, please list each full name with date of birth

**NOTE: PLEASE COMPLETE A SEPARATE FORM FOR EACH CHILD WITH UNIQUE NEEDS**

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