Special Needs Child Profile

Special Needs Child Profile

Highland Kids Special Needs Child Profile

  • Child's Information

  • Parent/Guardian Informtaion

  • Emergency Contact Information

  • Two people who are familiar with the child's habits and conditions.
  • Medical and Functional History

  • Releases

  • I give permission for the child listed above to participate in classes and/or activities at Highland Park Community Church. I authorize the volunteer and staff to administer emergency medical first aid treatment, or to call for emergency ,medical response.
  • Highland's Kids Special Needs program is designed to lessen the stress of families caring for a person with special needs. Because we will want to reach as many families as possible, in the future, we may publicize the program through television, radio and the newspaper. The use of your name, your child/adult’s name or picture is strictly voluntary. If you want to participate in our effort to help other families learn about Highlands’s Kids Special Needs program in the future, please electronically sign this form below. The picture may be used for press releases, journal articles, or other positive publicity related to Highland Park Community Church programs.