Flint Buddies Student Profile | Flint Baptist Church

Name

Age

Date of Birth

Dad's Name

Cell #

Email

Mom's Name

Cell #

Email

Student's Area of Struggle

Would you say your student could be seen as potential runner?

Is your student able to go to the restroom on their own?

Is your student able to communicate verbally?

Does your student have any specific food allergies?

If yes, please list them:

What are some specific trigger points with your student? (Examples: loud sounds, flashing or bright lights, large crowds, etc.)

What are some specific items that seem to soothe your students emotions? (Examples: specific toys, stuffed animals, fidget spinners, affection or hugs, etc.)

What are some of your students favorite toys, at school or at home? (If we were to create a tactical box for your student to soothe them or calm them, what might we include?)

Please list any medical issues or concerns our volunteers should be aware of:

Please share any additional information that may assist our volunteers in working with your student:

I am interested in:

Things I would like to see for my child in the Buddies Program: