For any K-5th grade child with a medical condition, learning difference, physical or intellectual disability who is unable to benefit from participating in the traditional church environment. Available during Sunday morning services.

Pre-registration of your child is required, please fill out and submit the form below.


Parent Questionnaire for Families with Special Considerations

Visalia First cares for each participant in our children’s ministry programming. These questions are asked for the benefit of your child and so that we may provide the best possible experience and safest environment for everyone involved. Our church and our children’s ministry workers respect your family’s right to privacy. Any information shared from this form is communicated directly with those caring for your child and only on a “need to know” basis. Please answer the below questions which apply to your child and that may help our church best minister to your child.

Date *
Today's date
Parent/Guardian Name *
Parent/Guardian Name
Parent/Guardian Phone *
Parent/Guardian Phone
Participant Name *
Participant Name
Date of Birth *
Date of Birth
My child is most comfortable in settings: *
My child does or does not enjoy music: *
My child would or would not enjoy a large group worship experience: *
My child is prone to seizures: *
I have read this intake form and verify that the information above is true. *
Permission/Authorization Agreement: *
Please read the following statements carefully and check the boxes to indicate that you have read, understand and agree to the provisions.
Enter your electronic Parent/Guardian Signature below to agree.
Date *