Special Needs Assistance Request

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Special Needs Registration Entry

Please complete the form below and we will follow up with you.

Child's Name (First & Last)

Child's Date of Birth

Child's Grade

Mother's Name (First & Last)

Mother's Phone Number

Father's Name (First & Last)

Father's Phone Number

Guardian's Name (First & Last)

Guardian's Phone Number

Best Email

Family's Address

DETAILS ABOUT YOUR CHILD:

Tell us about your child's strengths, interests and needs

Please check any/all health and medical needs that would allow us to support your child and keep him/her safe

Intellectual Disability Seizures Allergies Food Sensitivities Dietary Restrictions Other Medical or Learning Disabilities N/A

Use this space to tell us more about any needs you checked above

Please check any tasks with which your child requires help

Remaining on Task Understanding Directions Eating Staying in the Building Reading Aloud Making Friends Using the Bathroom Staying in the Class Communicating Writing Large Motor Skills Small Motor Skills Taking Turns Staying Calm at Church Managing a Large Space Separating from Parents Managing Loud Noises Managing Crowds N/A

Please use this space to expand on anything that was checked above

The best way to calm my child is

If my child needs the restroom, he/she will communicate by

When my child gets angry, he/she will

My child needs some prompting to maintain attention or take turns

I know my child needs a break when

What is your child's understanding of God and his/her relationship with Christ?

What spiritual goals do you have for your child?

How can we partner with you and your family as you work together to grow in Christ?

What can we provide for your child to help them best learn about Christ at Currey Creek?

1:1 Buddy Accommodations during Bible class/chapel such as designated seating; something to keep hands busy; noise cancelling headphones A small quiet classroom with lesson provided in more visual tactile style of learning

Submit

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Sundays at 8:00, 9:30 and 11:00am
35 Cascade Caverns Rd, Boerne, TX 78015-8311 | (830) 755-8806

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