Vineyard Kids Child Information Form

These questions allow us to provide the best experience and safest environment for all of our friends within the ministry. Our church leaders and ministry volunteers will respect your family’s right to privacy. Any information shared is communicated directly with those caring for your family member and only on a “need to know” basis. If you have any questions, please contact agiammalva@vckc.com for more information.

. What do you want us to know to best serve him/her?

Date

Does your child take any medication? If so, what kind?

Does your child express needs and wants by any of the following? Check all that apply:

Check all that apply:

Please list any medical or special precautions for managing seizures, g-tube, trach, positioning, respiratory, or allergies.

Please share any behaviors we should be aware of (i.e. aggressive behavior, tantruming, etc.)

Please explain how you handle behavior at home and school to help us maintain consistency in your plan.

Is there anything that your child is uncomfortable with or has sensitivities to?

Are there any trigger-points that lead to frustration and resistance? Are there any calming tools you use when this happen?

Please describe your child's understanding of God and their relationship with Him.

What are some goals that you have for your child at Vineyard?

Are there any ideas that you have so Vineyard can better serve your family?