Work Entry

VIP Intake Form

We want to serve your family well. This form will help us get to know you and your child. The 5 sections are...

The parent/guardian who will be signing the Permission and Authorization Agreement should be entered first.

First Name

Last Name

Mobile Phone

Show Spouse

What is the best way for our team to contact you?

All about my child

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

My child has a history of seizures

Yes No

Does your child have any allergies or food sensitivities?

Yes No

My child can have food while with the Student Ministry

Yes No

My child needs this type of assistance with eating/drinking