Fellowship Buddy Request

Thank you for filling out this form.  We respect your family's privacy and will only use this information for ministry purposes.  The information in this form is shared only with those involved in caring for your child so they will know and understand any special care needs.  Participation is dependent on availability of volunteers. 

We are so grateful that God brought your family to join us at Fellowship!

Student's Name:
Student's Date of Birth:
Father's name:
Father's Cell Phone:
Father's Email Address:
Mother's Name:
Mother's Cell Phone:
Mother's Email Address:
Home Phone (If available):
What do we need to be aware of regarding your child's disability/diagnosis?
Ex. Running away, aversion to touch, sit closer to teacher, don't ask to read aloud, avoid loud noises, etc.
What things or activities does your child like or dislike?
Does your child have any food or drink allergies that we need to be aware of?
If yes, please list all food and drink allergies.
Does your child need any assistance when eating or drinking?
If yes, please explain:
Which of the following best describes your child's communication level?
If your child uses sign language, which signs does your child use?
Special Needs Bathroom Policy 

Children ages 3 and up, who are in a diaper or pull-up, will need to be changed by a parent. The parent is the only one allowed to physically change a diaper, pull-up, or assist a child in the restroom. 

Please indicate that you have read and agree with Fellowship Kids bathroom policy.

*Acknowledgement of Bathroom Policy: