Northwest Unlimited - New Child Participant Form

Northwest Church cares for each child in our Northwest Unlimited ministry and we want to provide the best experience and safest environment for everyone involved. For that purpose we ask that you complete this form to the best of your ability. Prior to checking your child into Northwest Unlimited for the first time, the Unlimited team will reach out to you via a phone call to go over your child's specific needs.

Your child will not be able to attend the program on a Sunday if you have not had a phone call from the team leadership.

Our church and Northwest Unlimited leaders 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. One of our leaders of the Unlimited program will contact you once this form is received and reviewed. They will discuss any further information needed and schedule your child's first visit to the Unlimited program.

Your name *

Email address *

Phone number *

Household members

Here is where we will learn more about your family. Please click "Child" to add in your child's information.

Getting To Know My Child with special needs

We know that every child has their own unique abilities and struggles and the questions below are very important for us to be able to communicate the gospel to them. We think that every individual should have a relationship with Jesus Christ and we want to do everything we can to help them on that journey.

I understand that I must fill out this form separately for EACH child who is entering the Unlimited program (only those with special needs, not all siblings) *

If there is more than one child who will be entering our Unlimited program, then an additional form needs to be filled out for them. We want to know more about every child entering the program.

Name of the family member that needs assistance from the Unlimited team *

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 do these things independently:

My child needs assistance with:

My child is uncomfortable with or has an aversion to:

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:

The behaviors my child may exhibit are:

* Please Note: To protect all students and volunteers, parents will be notified if a child becomes aggressive and cannot be calmed using non-physical de-escalation techniques.

Does your child enjoy music?

Does your child seem most relaxed when alone, with a few children or among many children?

Would your child enjoy a large group worship experience?

My child is really picky about:

My child may be trying to communicate their need for...

...when he/she exhibits the following behavior. Please describe:

Is your child prone to seizures?

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

Is there any other information you’d like to share with us?

I have read this intake form and verify that the information is true. By placing my name below I agree to this being considered the same as my legal signature. *

Parent Signature *

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