Sunshine Kids Registration Form

Keystone 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.

Your name *

Email address *

Child's Name: *

Birthdate *

Desired Placement: (can be determined through conversation with Children’s Ministry staff, and changed through trial and error)

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

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

My child’s main mode of functional communication is:

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 use the toilet independently:

If No, Parent will be contacted via text message to come assist if bathroom use is needed.

My child needs assistance with:

My child is uncomfortable with or has an aversion to:

Something that helps my child through transitions is (visual schedule, personal timer, small object, etc) :

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

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 (select one) does /does not enjoy music.

Noise reduction earmuffs (select one) would/would not be helpful.

My child seems most relaxed in settings (select one) alone, with a few, among many children.

My child (select 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 (select one):

My child’s behavior may indicate a medical problem requiring immediate attention when…

Any other information that would be helpful for Children’s Ministry Staff or Sunshine Buddy to know:

I have read this intake form and verify that the information is true:

Please list your full name in lieu of a written signature.

Publicity Waiver *

There are those occasions when publicity pictures will be taken for newspaper articles, Facebook, keystonechurch.org and Keystone Church promotional and marketing materials.
Please select: YES - you may photograph my child(ren) or NO - you may not photograph my child(ren)

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