Friendship Class Registration

Friendship Class is our disability friendly Sunday School class offered to teens and adults. We ask that you fill out this form to help our teachers better serve you! If you are filling out this form on behalf of someone else, please answer all questions as it relates to the student.

Contact Information

Name

Address

This address will receive a confirmation email

Phone

Birthday

Gender

Emergency Contact Name

Relationship to Participant

Emergency Contact Phone Number

This number will be called if an urgent or emergent situation arises during Friendship Class and assistance or information is needed.

Alternate Emergency Contact Information

If primary emergency contact is not available or unable to be reached during Friendship Class.

Alternate Emergency Contact Phone Number

Physical

Do you have any allergies? (For example: food, environmental etc)

If you answered yes to allergies, please explain

There are times when food (i.e. a snack or special treat) may be offered during class. Do you have any special considerations that we should be aware of? (For example: Needs assistance to eat/drink, special diet, aspiration risk etc.)

Bathroom Policy (Please check that you have read and agree to our bathroom policy below)

Due to the sensitive nature of bathroom needs we feel it is the safest and best option to have personal needs addressed by a parent, caregiver, aid, guardian or other designated person where applicable. For those that need assistance, we ask that there always be such a person on church grounds (not necessarily in the classroom) at all times during class that can be contacted to assist the participant should the need arise.

Descriptions:
Independent: Can walk/navigate to the bathroom and able to care for personal needs
Partially Independent: Should be assisted to the bathroom but can take care of personal needs
Dependent: Unable to take care of personal needs and needs assistance (designated person should be contacted)

Please check that you have read and understood this policy as well as one of the following:

I have read and understand the bathroom policy Independent Partially Independent Dependent

Dismissal Policy

(If applicable) When class is dismissed is it okay for the participant to leave on their own or do you prefer that they wait until they are picked up?

Do you have seizures?

If yes, please explain how they present, their typical duration, and what you would like our teachers to do if you do have a seizure (i.e. call 911, call emergency contact etc.)

Cognitive/Intellectual

Specific type of disability

Feel free to describe below your disability so that we can best understand and meet your needs!

Sensory Preferences For example: Are you sensitive to loud noises, large groups, bright lights etc.

Communication Skills (please describe)

Reading/Writing Level (please describe)

Behavioral

Do you have any phobias, fears, or triggers? If so, how would you describe them?

Have you ever tried to run away? If so, describe the best way to prevent and/or handle that situation.

Do you display any behaviors that might disrupt the class? If so, what would be the best way to help you be successful in class?

Spiritual

Please answer as much as you are able or feel comfortable sharing

Describe your past Sunday School and/or church experience

Describe your understanding of God/relationship with Christ

Describe your strengths, special talents or gifts

Additional Information

Any additional information you would like to share with us?

Description

Please fill out this form and click submit.

Friendship Class Registration

Description

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