Connection Card Version 3.pages copy

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JOY MINISTRY

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1. ADULT/PARENT INFORMATION FULL NAME(S): __________________________________________________

JOY MINISTRY

start here!

1. ADULT/PARENT INFORMATION

FULL NAME(S): __________________________________________________

PRIMARY PHONE NUMBER:_____________________

DATE: _______________

PRIMARY PHONE NUMBER:_____________________

EMAIL ADDRESS: _________________________________________________

DATE: _______________

EMAIL ADDRESS: _________________________________________________

STREET ADDRESS: ________________________________________________

FIRST VISIT TO CARMEL: YES | NO

STREET ADDRESS: ________________________________________________

3. FOLLOW UP

BEING A CHRISTIAN | MEMBERSHIP | BAPTISM | EVENTS

I’D LIKE SOMEONE TO FOLLOW UP WITH ME I’D LIKE INFO (CIRCLE):

I’M NEW TO CHARLOTTE

CELL NUMBER: _____________________ WORK: _______________________ FAMILY INFO ADD’L EMAIL: ___________________________________________________

2. OPTIONAL INFO

I ATTEND ANOTHER CHURCH: YES | NO

CITY ______________________________________ STATE____ ZIP _______

FIRST VISIT TO CARMEL: YES | NO

CITY ______________________________________ STATE____ ZIP _______ I ATTEND ANOTHER CHURCH: YES | NO

2. OPTIONAL INFO CELL NUMBER: _____________________ WORK: _______________________ FAMILY INFO ADD’L EMAIL: ___________________________________________________

3. FOLLOW UP I’M NEW TO CHARLOTTE

BEING A CHRISTIAN | MEMBERSHIP | BAPTISM | EVENTS

I’D LIKE SOMEONE TO FOLLOW UP WITH ME I’D LIKE INFO (CIRCLE):

I WANT TO CONNECT:

VISIT THE PORCH TO TALK TO SOMEONE ABOUT CONNECTING TO CARMEL.

DISCIPLESHIP COMMUNITIES | A PASTOR | SERVING OPPORTUNITIES

I WANT TO CONNECT:

ANY PRAYER REQUESTS OR QUESTIONS?

DISCIPLESHIP COMMUNITIES | A PASTOR | SERVING OPPORTUNITIES

ANY PRAYER REQUESTS OR QUESTIONS?

VISIT THE PORCH TO TALK TO SOMEONE ABOUT CONNECTING TO CARMEL.

Be sure to complete Section 1 first!

4. CHILD INFORMATION

JOY CLASS

Be sure to complete Section 1 first!

4. CHILD INFORMATION

JOY CLASS

DIETARY NEEDS:_______________________________________________________________

__________________________________________________________________________

GESTURES, FACIAL EXPRESSIONS, SIGN LANGUAGE, ETC.)____________________________________

MOST FREQUENTLY USED METHOD OF COMMUNICATION (VERBALIZATIONS, VOCALIZATIONS, EYE GAZE,

SCHOOL:____________________________________________________________________

TYPE OF DISABILITY ____________________________________________________________

FIRST VISIT: YES | NO

ACCEPTABLE FOODS/LIQUIDS THAT MAY BE CONSUMED:_____________________________________

DIETARY NEEDS:_______________________________________________________________

__________________________________________________________________________

GESTURES, FACIAL EXPRESSIONS, SIGN LANGUAGE, ETC.)____________________________________

MOST FREQUENTLY USED METHOD OF COMMUNICATION (VERBALIZATIONS, VOCALIZATIONS, EYE GAZE,

SCHOOL:____________________________________________________________________

TYPE OF DISABILITY ____________________________________________________________

FIRST VISIT: YES | NO

CHILD NAME: _________________________________________________AGE: ____________

ACCEPTABLE FOODS/LIQUIDS THAT MAY BE CONSUMED:_____________________________________

BEHAVIORAL CONCERNS (CHALLENGING BEHAVIORS, FEARS):_________________________________

CHILD NAME: _________________________________________________AGE: ____________

BEHAVIORAL CONCERNS (CHALLENGING BEHAVIORS, FEARS):_________________________________

PHYSICAL NEEDS (POSITIONING, HEARING/VISION, ETC)_____________________________________

WHEELCHAIR: YES | NO

PHYSICAL NEEDS (POSITIONING, HEARING/VISION, ETC)_____________________________________

MEDICAL CONDITIONS (SEIZURES, ASTHMA, DIABETES, ETC):__________________________________

GENDER: MALE | FEMALE

MEDICAL CONDITIONS (SEIZURES, ASTHMA, DIABETES, ETC):__________________________________

TOILET NEED:_________________________________________________________________

HOUR: 9:30 | 11:00

TOILET NEED:_________________________________________________________________

FAVORITE ACTIVITIES:____________________________________________________________

SIBLING NAME: ______________________________________GRADE: _______

WHEELCHAIR: YES | NO

FAVORITE ACTIVITIES:____________________________________________________________

OTHER INFORMATION:____________________________________________________________

SIBLING NAME: ______________________________________GRADE: _______

SIBLING NAME: ______________________________________GRADE: _______

GENDER: MALE | FEMALE

OTHER INFORMATION:____________________________________________________________

___________________________________________________________________________

HOUR: 9:30 | 11:00

___________________________________________________________________________

SIBLING NAME: ______________________________________GRADE: _______

SIBLING NAME: ______________________________________GRADE: _______

5. SIBLING INFORMATION

SIBLING NAME: ______________________________________GRADE: _______

ALLERGIES/HEALTH CONCERNS:_______________________________________

5. SIBLING INFORMATION

ALLERGIES/HEALTH CONCERNS:_______________________________________