Buddy Ministry Inuiry

Thank you for inquiring about Nativity's Buddy Ministry. Please fill out the form below and we will be in contact with you shortly.

*First Name

*Last Name

*Email Address

*Phone Number

*Address Line 1

Address Line 2

*City

*State/Province/Region

*Zip/Postal Code

Child's Name:

Child's Nickname:

Child's Birthday:

*Child's Grade Level:

Parent/Guardian Name(s):

Cell Phone:

Email Address:

Does your child have allergies/medical concerns?:

YesNo

If no, please explain bathroom assistance needs:

Is your child independently toilet trained?:

YesNo

How will your child communicate bathroom needs?:

What are some of your child's favorite things?:

What might cause your child to become upset?:

What comforts your child when he/she is upset?:

What would you like us to know about your child?:

What are your hopes of the Buddy Ministry for your child?:

What program is this child currently attending?:

I understand the information on this form will be shared confidentially with ministers serving my child

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