Special Needs Ministry: Buddy Program Inclusion Form

My child's specific diagnosis

What are some of your child's strengths and interests?

I need the church to understand the following about my child

What does it look like when my child struggles to regulate their emotions? What helps them to regulate?

Here are some things we (parents) do at home when this happens

My child is sensitive to (e.g. lights, loud music, specific textures etc)

Is your child prone to eloping/running off? If so, what are the triggers and how do you handle it?

My child can let you know what he/she needs

Mobility is impacted

Not at all

Mildy

Moderately

Profoundly

My child is

Toilet trained

Toilet times

In diapers

How does your child socialise with other children?

What kind of communication does your child employ?

What are the main risks leaders need to be aware of? ie. biting, absconding, pinching

What is the risk plan you have as a parent and are you okay with leaders employing the same plan?