Special Needs Ministry Registration

Parent's Name

Child's Name

Age

This address will receive a confirmation email

Phone

Allergies?

Yes No

If yes, please list allergies here:

Describe Your Child’s special need(s)

Does your child have triggers/sensory concerns or exhibit aggressive behaviors? If yes, please describe.

Is there anything we need to know to help us make this a positive experience for your child? (such as shyness, need for encouragement to participate, etc.)

Photography Release

Photography Release: I understand that photographs may be taken at any Activity, Program or Event of The Presbyterian Church of Toms River and agree to allow these photographs without names to be used for display and/or posting on an internet website by The Presbyterian Church of Toms River.

Photography Release

Yes No

Description

Please fill out this form and click submit.

Special Needs Ministry Registration

Description

Please Fix the Following