Cornerstone Presbyterian Church - PA - Disability Intake Form

Disability Ministry Family Intake Form

Our desire is to partner with your family so that each child can participate fully and joyfully in our church programs.
Please complete this form to help us understand how to best support your child.

Parent / Guardian Name(s):

Phone Number

Email

Child's First Name

Child's Last Name

Birthdate

Grade

Allergies / Medical Conditions

Diagnosis or Special Needs

Triggers / Calming Strategies (what helps your child when upset or overwhelmed)

Emergency Contact First Name

Emergency Contact Last Name

Emergency Contact Phone Number

Additional Notes/Questions

“Let each of you look not only to his own interests, but also to the interests of others.” – Philippians 2:4 (ESV)