Rise Kids Embrace Intake Form

Our goal is to create individualized plans for children with extra needs or disabilities, allowing them to safely participate with their peers in church on Sundays. We provide a Jesus centered experience for every child, allowing their parents to attend church knowing that their child is being well cared for.

Your child is a superhero when they are in Rise Kids! Our hope is to provide your superhero with a sidekick in class, because every superhero needs their sidekick!

Please answer the following questions as thoroughly as possible. This information will be given to your child's sidekick so that they can best care for and support your child.

Please note that Embrace is currently offered at the 10am service on Sundays. Once we receive your intake form, we will review it with our team and determine if we can support your child on Sundays. We will reach out with any additional questions.

If you have any questions or concerns, please reach out to Jenna Standish (jenna@rise.cc).

Your name *

Email address *

Phone number *

What is your child's name, age, and birthdate? *

What learning differences, diagnosis, or medical condition does your child have? *

Are there things that your child needs assistance with? (ex. using the restroom, writing, reading, etc) *

Are there things that your child is uncomfortable with? (ex. loud noises, bright lights, etc.) *

Are there things that frustrate your child? Are there any specific behavioral issues that we should be aware of? *

If so, what are the best strategies for calming them down? *

Tell us about your child’s understanding (ex. understands yes/no questions, 1-2 step directions, etc.) *

Tell us about how your child expresses themselves (ex. uses sign language, non-verbal, speaks some words, speaks full sentences, etc.). Do you use any visual aids to support communication? *

Tell us about how your child moves (ex. sits, crawls, walks with supports, uses a wheelchair, transfers, etc.) *

What does your child enjoy doing? What are their current interests or favorite toys? *

If your child is in elementary school, they will go into the Aux with kindergarten through 5th graders for live teaching and worship. How can we best support your child during that time?

Are there any other specific health or safety concerns that we should be aware of? Please add anything else you would like us to know about your child.

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