Special Needs Form Child Name * First Name Last Name Parent(s)/Guardian(s): * Contact Information * Age of Child * How does your child communicate? * Verbally AAC Sign Language Other (Write Below) What motivates your child? * How can we best support your child if they become frustrated or overwhelmed? * Are there any strategies used at home or school that could be implemented during Jr. Church to help support your child? * Does your child elope? (Leave a designated area without warning)? * Yes No Are there any additional health or safety concerns we should be aware of? * What else would you like us to know about your child? * Thank you!