New Student Registration - Haven Ministries

The following questions are asked for the benefit of your child, and so that we may provide the best experience and safest environment for everyone involved. Our church leaders and ministry volunteers respect your family's right to privacy. Any information shared from this form is communicated directly with those caring for your child and only on a "need to know" basis.

Your name *

Last name

Email address *

Child's Information

First Name *

Last Name *

Gender *

Male

Female

Birthdate *

Grade *

Age-Appropriate Ministry Environment (check one) *

Pre-K Hallway (6 Weeks to 5yrs)

Elementary (Kindergarden - 2nd Grade)

Elementary Academy (3rd Grade - 5th Grade)

Allergies *

Diagnosis/Disability *

Current Specialized Programs *

Current Medications *

Parents / Guardian Information

Primary Parent / Guardian First Name *

Primary Parent / Guardian Last Name *

Primary Parent / Guardian Cell Phone Number *

Primary Parent / Guardian Email Address *

Secondary Parent / Guardian First Name *

Secondary Parent / Guardian Last Name *

Secondary Parent / Guardian Cell Phone Number *

Secondary Parent / Guardian Email Address *

Address

Country

Street Address

Apt/unit/box (optional)

City

State

Postal code

Home Phone Number

Emergency Contact

Emergency Contact Name and Number *

Emergency Contact Relation *

Strengths / Weaknesses

Emotional / Behavioral *

Social *

Communication *

Health / Medical *

Sensory *

Visual / Hearing Impairments *

Anything else you want us to know about your child

Least Restrictive Environment

What do you foresee your family member’s Least Restrictive and Appropriate Environment to be at church? *

Inclusion with no support

Inclusion with extra support in the room

Inclusion with one-on-one assistance

Small group with children of similar disabilities

Unsure and would love to schedule a call to discuss my child's specific needs

Privacy Statement

By signing your first and last name below, you are agreeing with the Privacy Statement below. *

Renovation Church cares for each participant in our Haven ministry. The questions in this document are asked for the sole intent of benefiting your family member. The questions will help us provide the best experience and safest environment for everyone involved. Our church leaders and ministry volunteers respect your family’s right to privacy. Any information shared from this form is communicated directly with those caring for your family member and only on a need to know basis. The information is kept in a secure location, but made available to all who may work with your family member. You have the right to access the information at any time by contacting the Renovation Kids Director.

Renovation Church Mission Statement

By signing your first and last name below, you are agreeing with the Mission Statement below. *

The Renovation Church Family Ministry seeks to partner with parents to make disciples of Jesus Christ. The purpose of our special needs ministry is to facilitate an inclusion environment, when appropriate, in order that we may help each person grow in his/her spiritual relationship and participate with peers in regularly scheduled church services and church sponsored activities. The objective(s) of the ministry are to:
(1) Create an accepting church environment for families impacted by special needs or disabilities. (2) Develop an accommodation plan for the individual(s) with additional needs that benefits the individual(s) while working within the policies and resources of the church.
(3) Assist identified individuals so that they may experience success in a church setting.
Services provided by the special needs ministry may be requested by the individual, the family of the individual, or by ministry leader(s)/volunteers working with the individual. The special needs ministry may provide services based on a broad range of unique needs and requirements. The decision to provide services or not provide services through the special needs ministry will be made through a team consisting of, but not limited to, the Renovation Kids Director, specific ministry leader(s), volunteer(s) working with the individual, parents of the individual, and the individual when appropriate. Services may be on-going or for a limited time, depending upon the severity of the need and availability of resources.
The Haven Ministry of Renovation Church does not provide therapy programs, behavior modification programs, medical intervention, or advice/recommendations for such. To the best of our abilities, our ministry servants will strive to follow guidance from and utilize tools and suggestions provided by parents and professionals who work with the individual. Medical assistance will be provided in emergency situations, as documented in the church wide policies and procedures.
We seek to provide the best experience and safest environment for everyone who participates in the Haven Ministry. We welcome your family and your child(ren) to participate in church services and activities as you grow spiritually, get connected with others, and serve in your community and within the church.

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United Church
hello@renovationchurch.com
404-414-0589