Questionnaire for Caregivers of Children with Special Needs

Welcome to our children’s ministry!
We are so happy that your child is here! Please answer the below questions to the best of your ability to help us get to know your child and serve your family better as you worship with us.


What can we do to make church a happy place for your child?

How can we help you and your child worship?

What are your child’s preferred activities or toys?

What helps your child feel comfortable in a new situation?


Would you like for your child to have a trained 1-on-1 buddy with them in their class?

Does your child use assistance for mobility? Walker, wheel chair? 

Does your child have any food allergies or sensitivities?  


Are there certain triggers or things that make your child upset so we can avoid or reduce them? (For example: certain sounds, touch, seating arrangements)

What helps your child to calm down if he/she becomes upset? (ie. taking a break, singing a particular song, going outside, a big hug, reading a book, rocking) 

Are there certain verbal cues or phrases that you use with your child with regard to helping him or her with understanding appropriate behaviors? For example, a cue to not hit for a child that is prone to hitting, may be ‘gentle hands.’ 


What toileting accommodations are needed?

Does your child require diapers or protective undergarments?  Do you give us permission to change your child, if needed?  

If your child is schedule trained please indicate the time/s that you would like us to take him/her to the restroom. 


You will be contacted if your child has a meltdown that lasts more than 5 minutes.

If you would like to be contacted earlier, please indicate the time you would like for us to contact you: _____ minutes

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