Special Needs Resources

Special Needs Intake Form

We desire to be a church in which people of all types and abilities feel welcome and comfortable to worship. If you, a friend, or family member should require special accommodations in order to participate in church activities, please complete the form to the right.

Name of Person Completing Form

First Name

Last Name

Relationship to Person with Special Needs

Please answer if completing this form on behalf of someone else.

Email

Phone

(###)

###

####

Name of Person with Special Needs

Please answer if completing this form on behalf of someone else.

First Name

Last Name

Age of Person with Special Needs

Child Between Ages 0-3

Child Between Ages 3-6

Child Between Grades K5-5

Youth Between Grades 6-12

Adult

Gender of Person with Special Needs

Male

Female

Special Needs Resources

Special Needs Intake Form

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