PCCLift Small Group Interest Form | Perinton Community Church

PCCLift Small Group Registration Form

Thank you for your interest in the PCCLift small group. This group is for parents of children with special needs. We look forwarding to studying God's word and doing life together!

Today's Date (Required)

Names of Parents Attending (Required)

Your email (Required)

Your Phone Number (Required)

Your Address (Required)

Please share what your specific needs or interests are for attending this group. (Required)

Please select any that apply.

Support from other parents

Studying God's word with other believers

Building community

Helping my child(ren) be comfortable with attending church

Other (please explain below)

If other, please briefly explain.

Do you need childcare? (Required)

Childcare is available for children with special needs and their siblings in order for parents to attend the small group.

Please list the names and ages of your children who need childcare.

If you need childcare, please answer the following questions in order for us to provide the best care for your children.

Do any of your children have a physical disability?

If one of your children has a physical disability, please describe what his/her needs are.

Do any of your children have a developmental or behavioral disability?

If one your children has a developmental or behavioral disability please describe what his/her needs are.

In addition to this registration form we ask that you complete a Behavioral Support Plan and/or Physical Support Plan for any child with special needs requiring childcare. A link will be sent to the email you provided above.

If you already have a completed support plan through school, etc. you may submit that instead.

Do you need to complete a support plan for your child(ren)?

Behavioral Support Plans are for children with developmental and behavioral needs that may require support to prevent or deescalate a crisis. Physical Support Plans are for children with physical disabilities that may require adaptions to their environment, such as an elevator for wheelchair accessibility.

Yes, I need to complete a Behavioral Support Plan

Yes, I need to complete a Physical Support Plan

Yes, I need to complete both a Behavioral and Physical Support Plan

No, I will provide copies of previously completed support plans

Thank you for completing the registration form for the PCCLift Small Group. Some one will be reaching out to you shortly!

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Service Information:

Bible Classes: 9:15-10:15am

Worship Service: 10:30am - 11:45am

Perinton Community Church

636 High Street Extension

Fairport, NY 14450

585-223-7494

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