No Boundaries Parent Assessment Tool

* Child's Full Name
* Parent's Email
* Today's Date
* Child's Date of Birth
* Child's Age
* Parent's Name(s)
* Best contact number
* Who does the child reside with?
* List child's siblings and ages
* Church you regularly attend
* Type of placement in school
* What medical diagnosis has been made regarding your child's special needs?
* Check any applicable information that might be helpful for volunteers to best minister to your child. (To make more than one selection press CTRL while highlighting.)
Add any explanation that you feel may be helpful in regards to the above.
List any allergies
* Is your child on any medication?
If so, what medications and how are they administered?
Helpful/special suggestions about your child (for example, "redirect my child by . . ."
* Is your child's speech understandable to other people who don't know him/her?
* How does your child communicate basic needs (using toilet, asking for a drink . . .)?
* Does your child use sign language or a sign board?
Are there other special care needs we should be aware of?
The goal of No Boundaries is to include your child with special needs in all activities of mainstream Bible study classes and peer group fellowship activities. What will your child need in order to make this happen? And at what activities will they need assistance?
* Check only those you feel apply to your child. (To make more than one selection press CTRL while highlighting.)
Please add any additional needs or clarifying statements.
If your child is having a difficult time, at what point do you want to be notified?
 


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