OGC Children's Ministry Accommodation Form

Name of child *

Household member needing accommodations

My child has the following diagnosis, medical conditions, or learning difference: *

Obtaining the diagnosis for a child is not crucial to developing a successful plan. However the more shared about a child will increase the likelihood of developing a successful plan to partner with the family.

My child's main mode of functional communication is:

How does your child receive and communicate information? Ex. primarily verbal, auditory, or visual means. This helps teachers modify or adjust a lesson to appeal to a child's particular learning style.

My child has the following allergies and/or food sensitivities:

Please note if your child has the potential for an anaphylaxis type reaction

The goals I have for my child's development this coming year include (behavioral, social, etc.):

The church may not be able to achieve all of a parents objectives, it really helps to know what the family's hopes are to partner well.

My child can do these things independently:

Please include bathroom needs so we can determine help for diapering/toileting needs over the age of four

My child needs assistance with:

Ex. transitions, peer interaction, music/worship, teaching time, craft, snack time

A trigger-point for resistance, frustration, or behavioral problems may emerge for my child when:

This will help us learn how to prevent and manage problems before they start

When/if my child experiences a period of frustration, he/she calms when we:

Doing/seeing/experiencing this one thing is an important part of my child's routine:

My child seems most relaxed in a setting:

alone

with few children

among many children

Unsure

My child may be trying to communicate their need for (describe) __________ when he/she exhibits the following behavior:

My child's behavior may indicate a medical problem requiring immediate attention when:

Would you like for your child to utilize the Buddy program if/when available? *

Yes

Unsure