NT Kids Special Needs Ministry

NT Kids Special Needs Ministry Form

Child's Name

First Name

Last Name

Birthdate

MM

DD

YYYY

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone Number

Guardian's Name

First Name

Last Name

Sibling's Names

If siblings, what grades are they in?

Disability

Medications

*Medications will not be given during NT Kids

Allergies

Seizures

If yes, what do they look like.

Restroom Needs

*If child is not potty trained, diapers will not be changed during NT Kids

Child's Interests

Behaviors

Triggers

Calming Strategies

Suggestions