Kidlife Buddy Questionnaire

Please Note: Nothing surprises us or makes us nervous. We simply want to best prepare our buddy team to welcome your child, keep them safe, and ensure their experience at Brooklife Church reflects God’s love for them. Any information you provide will be kept confidential within our staff and buddy team.

Your name *

Email address *

Please add click "add child" below for the child you are filling out this form for.

You will need to re-fill out a separate form for each child.

Household members

Health

Child's Age: *

Child's Approximate Developmental Age: *

Please provide a brief description of your child's identified diagnosis (educational or medical): *

Does your child have a history of seizures? *

Yes

Is your child verbal? *

Yes

Does your child require assistance with eating/drinking and/or using the restroom? *

Yes

Any allergies or other health concerns you feel we should be aware of?

Interests and Behavior

What are some things that your child loves to do or play with? Other interests? *

What activities seem to be more challenging or difficult? Please include fears or dislikes as well. *

Does your child have any behaviors that might be harmful or disruptive to themselves or others?

If yes, what does that typically look like, and what is beneficial in de-escalating and calming those behaviors?

What physical or behavioral supports are most beneficial for your child? *

Is there any additional information that you would like us to know? Please include any physical, social, emotional or spiritual needs you'd like us to be aware of.