SOUL Champions Support plan form

Phone number *

consent to completing a SEND support plan and my child completing a one page profile and to Soul Church securely holding this information. *

I understand that I may be asked to attend soul kids/soul youth/soul champions with my child/young person if my child/young person has support needs that our team are not yet equipped for.. *

I am happy to provide and for SOUL church to hold any relevant EHCP/PSP/risk assessment for my Child *

I consent to a risk assessment being put in place for my child if necessary to ensure they are kept safe as well as our team. *

I would like to be added to the parents whatsapp community where I can ask questions and find out what my Child is learning.

Name of Child *

Birthdate *

What area of Church are you planning on attending? *

SOUL kids

SOUL youth

SOUL champions

What type of school does your Child attend (If any) *

In the case of an emergency would your child require special assistance to evacuate the building? *

If "yes" please Disclose further details

Yes

No

Does your Child/young person have a diagnosis or suspected diagnosis if so please specify? *

Does your Child/young person have any medical needs/allergies relating to their diagnosis stated above if so please specify? *

please provide as much detail as possible to ensure the safety and care of your child.

Does your child have full sight & hearing? *

Yes

No

Does your Child have any other additional needs? *

Please provide further detail on your child or young persons support needs.

Does your child have any communication differences? *

For example being non speaking or using AAC

Yes

No

Does your child have any mobility needs? *

Yes

No

Does your child have any special interests? *

What Dislikes/ Triggers does your Child have? *

This is key to preventing distress to your child, please answer clearly.

Does your child have any behaviors that could harm themselves or others? *

Yes

No

If your child was upset or distressed, how would you advise we comfort them? *

This is key to us effectively caring for your child, please be as detailed as possible.

Call the Parent/Carer

Physical Touch

Use of the Calm Zone

Snack/Refreshement

Going outside

Movement Activities

Sensory Input

Distraction

Other