VBS Special Needs Survey (Optional)

Child's Name

Parent/Guardian Name

My child has the following educational label or medical diagnosis:

My child’s primary means of communication is:

Additional information concerning my child’s allergies or food sensitivities:

My child’s favorite activities and interests are:

My child avoids doing or becomes easily frustrated with the following activities:

If my child becomes overwhelmed or frustrated they will respond best to:

My child’s strengths are:

My child needs help with:

What suggestions do you have that may help us create the best possible experience for your child?

What information would you like us to share with other children at VBS that will help them to better know, accept and understand your child?

Orangeville Seventh-day Adventist Church