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Blackhawk Kids // Kids With Special Needs
To start a conversation with someone on the Blackhawk Kids' team regarding your child and Sunday programming, please fill out the form below.
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First Name
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Last Name
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Email Address
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Phone Number
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CHILD'S FIRST NAME:
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CHILD'S LAST NAME:
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DATE OF BIRTH:
SITE YOUR FAMILY ATTENDS:
Blackhawk Brader Way
Blackhawk Downtown
Blackhawk Fitchburg
Undecided
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THE CHILD ABOVE:
-- Select --
has a behavioral condition we want you to be aware of.
has a behavioral condition that may interfere with participation.
has a medical condition we want you to be aware of.
has a medical condition that may interfere with participation.
has a learning delay we want you to be aware of.
has a learning delay that may interfere with participation.
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SPECIAL NEED:
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GENERAL INFORMATION
What behaviors might we notice and how can we best respond?
ADDITIONAL ASSISTANCE
What type of assistance do you think would be the most beneficial to your child while attending our kids' programming?
NONE: (No extra assistance is required. I just want you to be aware.)
INCLUDER:** (A one-on-one volunteer who can assist during programming in ways unique to the individual child.) *available on Sundays
PARENT ASSISTANCE: (A parent/guardian will provide assistance for the child.) *available on Sundays
**If you indicate that an Includer is needed, someone from the Blackhawk Kids team will follow up with you to connect on how we can best partner with you during programming. We ask parents/guardians to stay with their child the first week as staff and parents assess the child's needs and how to best serve him or her in Sunday programming.
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CONSENT TO DISCLOSE MEDICAL INFORMATION
Your signature indicates that the above information is complete and accurate and gives Blackhawk permission to share this information with others to ensure the safety of your child and others.
Typing your name below sufficiently serves as your signature.
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Parent / Guardian Signature:
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Parent / Guardian Email Address:
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Parent / Guardian Phone:
Submit Form