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Special Needs Ministry Intake Forms

July 8, 2010

I have seen a handful of special needs parent questionnaires and they all differ. Some churches have very detailed intake forms that look like something a skilled professional would complete inside a patient’s file.  Other churches ask one or two open ended questions that may fail to draw out critical information.  Below is a list of idea-starters for an intake form.   I personally like it when a representative of the church goes through the questions one-on-one with parents.  This conversation can ease the mind of a family who fears that an honest answer about their child may yield rejection from the church.  In addition,  I do think it is important for the parents to complete this form themselves and in writing.  This practice ultimately protects the child and the church.

Keep in mind that certain terms and local practices within nearby schools may influence the questions and wording on an intake form.  It might be helpful to ask a contact from a local school to review your church’s questionnaire.  Organizations that equip churches for respite are also excellent sources for help.  Last but not least, the church’s attorney and insurance carrier may offer guidance for all special needs-related ministry forms.

**Please note that I am not an attorney nor a credentialed professional from the medical or educational fields.  Please do not rely on this post (nor any post on this blog!) as your sole source for developing good practices for special needs accommodation.  Part of good planning includes proactively contacting your church’s attorney and insurance carrier to discuss potential policies & procedures.**


Parent Questionnaire for Children with Special Considerations:

Our church cares for each participant in children’s ministry programming.  These questions are asked for the benefit of your child and so that we may provide the best experience and safest environment for everyone involved.  Our church and our children’s ministry workers respect your family’s right to privacy. Any information shared from this form is communicated directly with those caring for your child and only on a “need to know” basis.   Please answer the below questions that apply to your child and that may help our church best minister to your child.

  • My child has the following diagnosis, medical condition or learning difference:
  • My child has the following allergies and/or food sensitivities:
  • My child’s allergies can be life threatening (circle) Yes/No and require the use of an EpiPen Yes/No
  • My child’s main mode of functional communication is:
  • My child processes instruction or information best when:   (e.g. visual, auditory, experiential, drama).
  • My child currently receives therapies and special instruction in:
  • My child has an Individualized Education Plan Yes/No
  • If answered “yes”, please describe child’s IEP:
  • The goals I have for my child’s development this coming year include (behavioral, social, academic, etc):
  • My child has the following area(s) of interest:
  • My child can do these things independently:
  • My child needs assistance with:
  • My child is uncomfortable with or has an aversion to:
  • A trigger-point for a potential meltdown is when:
  • When/if my child experiences a melt-down he/she calms when we:
  • Doing/seeing/experiencing this one thing is an important part of my child’s routine:
  • My child (circle one) does/does not enjoy music
  • My child seems most relaxed in settings (circle one) alone, with a few children, among many children
  • My child (circle one) would/would not enjoy a large group worship experience
  • My child is really picky about:
  • My child may be trying to communicate their need for (describe) ______ when he/she exhibits the following behavior:
  • My child is prone to seizures (circle one) Yes/No  If yes, tell what prompts the seizure and how we can prevent/respond:
  • My child’s behavior may indicate a medical problem requiring immediate attention when:

For two sample intake forms/parent questionnaires, see the following two posts:

Conducting a Parent Interview for Special Needs Ministry Intake Forms

Best Practices:  Spotlight on Johnson Ferry Baptist Church Part 1

Developing a Special Needs Ministry’s Goals & Mission.

Like this post or any of its content?  See my blog entry Rules for Repost.

Amy Fenton Lee

  1. Awesome questions!!!! It’s always hard to condense things down to so little but you got the very key ones, only thing I’d add is toileting, and feeding. As a parent of a child with multiple disabilities these two are kind of the big two. Also perhaps something about whether or not you administer medication, I know most churchs don’t considering insurance and certain liabilities but it’s a question that always seems to come up haha, So yeah, that’s just food for thought, but stressing the need to look at church insurance and policies is key.

  2. Katie Garvert permalink

    I love this Amy. I may be doing a revamping of my profile with these questions -much more user friendly. Great info on your blog. Thanks again.

  3. Thanks Katie – I love what you are doing at Woodmen Valley Chapel and I look forward to spotlighting you guys on the blog.

  4. Salvador – Thanks for your comment. Somehow it ended up in my spam box (sorry!). Toileting, feeding and medication are possible issues but most church special needs ministries (outside of respite care) can’t do any of these due to liability issues. The majority of churches I interview (who have really well-thought out programs where insurance companies have been proactively consulted) require parents to do all toileting and medicine administration. The churches who do take on these responsibilities either hire an agency to provide an insured nurse (to diaper and administer meds) or they provide pretty in-depth (and sometimes expensive)training for their workers. I will share more ideas and examples in an upcoming post.

    Many churches put their own touch on how they meet the specific needs of their families. And often that is shaped by the culture inside their local school systems and the advisement of their local attorney. In the meantime, thanks for reminding me to address this issue in greater detail. Stay tuned!

  5. Hi,apart from sending information regarding the childrens ministry one ministry I am deeply interested in for future ministry is to know and be informed more about special needs children especially children who are disabled. I am also deeply interested in what lessons and what resources apart from pictures one would be able to use in order to get through to say a child who has cerebral palsy or epilepsy if they can’t say go to a normal school to get an education and how one would preach or speak to these children. I am also interested in what methods one could and would use so if you would update me on this area as well as the normal e-mails I received from Tommy Kummer It would be really appreciated.

    God Bles Bryony

Trackbacks & Pingbacks

  1. Implementing a S.N. Program in a Small Church « The Inclusive Church
  2. Starting a Special Needs Ministry « The Inclusive Church
  3. A Personal Note « The Inclusive Church
  4. Top 10 Posts & Blog Update « The Inclusive Church
  5. 4 Steps for Taking your Special Needs Child to New Church
  6. Developing a Special Needs Ministry’s Goals & Mission « The Inclusive Church
  7. Children's Ministry Forms & Printable Templates
  8. Children’s Ministry Forms & Printable Templates | RSS News Feeds
  9. Happy 1st Anniversary The Inclusive Church Blog! (And Top 10 Posts) « The Inclusive Church
  10. Modifying For The Individual Not The Disability « Special Needs Ministry
  11. Top 10 Posts for the Last Year « The Inclusive Church
  13. Conducting a Parent Interview for #SpNeedsMin Intake Forms « The Inclusive Church

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