EmailMeForm
AUTISM MINISTRY INTEREST FORM
Thank you for your interest in the Autism Ministry at Word of Restoration International Church.
Our goal is to create a welcoming and inclusive space for autistic individuals and their families. Please take a few moments to fill out this form so we can better understand your needs and how we can serve you.
1. Name
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First
Last
2. Phone
*
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3. Email
*
4. Are you filling this out as:
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A parent/caregiver of an autistic individual
An autistic individual
A potential volunteer
A church leader/staff member
A certified clinician/teacher
Other
5. Specialty Area (if applicable)
Do you have any relevant experience, training or certification?
No experience
Special Needs Educator
Child/Adolescent Counselor
Social Worker
Developmental Pediatrician
Child Neurologist
Child/Adolescent Psychiatrist
Clinical Psychologist
Speech-Language Pathologist
Other (if you checked 'Other' briefly describe your credentials or experience in the box below)
Place credentials or experience here:
Interest & Needs
6. What services or support would you like to see in an Autism Ministry?
(Check all that apply)
Sensory-friendly worship services
Sensory-friendly area during services
Support group for parents/caregivers
Social opportunities for autistic individual
Training for church volunteers/staff
One-on-one buddies for church activities
7. What age group(s) would this ministry primarily serve in your household?
Preschool (0yrs-5yrs)
Elementary (6yrs-11yrs)
Teen (12yrs- 16yrs)
8. What accommodations or support does your family/child/you need to feel more included in church activities?
9. Are there specific challenges you've faced in attending church?
10. What is your child's or children's diagnosis? ( if applicable)
10. Would you be interested in volunteering for this ministry?
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Yes
No
Maybe-I'd like more information
11. If volunteering, how would you like to be involved? (Check all that apply)
Working directly with autistic individuals
Teaching/assisting in a class or group
Provide sensory-friendly resources
Helping with events and activities
Administrative or behind-the-scenes support
12. Would you like to be notified about upcoming meetings or events related to this ministry?
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Yes
No
Not at this time
13. Best way to contact you about updates:
*
Email
Phone call
Text message
Other