Inspire Ministry Form

The Inspire Ministry is available to individuals with special needs or disabilities at Colonial Baptist Church. For security purposes and because of the personalized care offered through this ministry, we will try to provide the reasonable accommodations listed above to the best of our ability. Please note that if we are unable to provide any of the reasonable accommodations listed on this form, we will notify the parent or caregiver as soon as possible. If you have any questions, please contact Alisha Williams at alishaewhite@yahoo.com.

Section 1: Contact Information

Date*

First Name*

Last Name*

Date of Birth (MM/DD/YYYY)*

Age*

Gender*

Address*

City*

State*

Zip Code*

County*

Parent/Guardian Name*

Relationship to child*

Primary Language*

Cell Number*

Email*

Alternate or Emergency Contact Person*

Section 2: Getting to Know You

Please share any information that will help us better serve and equip you in Colonial.

Identified condition or medical diagnosis (e.g., Spina Bifida, Down Syndrome)

Please describe you or your child's special need. Feel free to include your own inclusions.

Please check area[s] that apply

Other, specify Comments

Church Service: Please describe the reasonable accommodations needed

Prayer Needs or Other concerns

Section 3: Ministry Needs Assessment

What are your interests?

How can we serve you and/or your family?

How would you like to serve others?

Please list any additional information on the care of you and/or your loved one in the space below

Submit