Respite Night Registration Lebanon Church’s Through The Roof Special Needs Ministry will be starting Respite Night. Please fill out the form below and submit it to Register. If you have any questions please contact Becky Blow at firstname.lastname@example.org or call 843-618-1324. Have You Previously Attended A Through The Roof Ministry Event? (required) YesNo Child's Name (required) Birthdate (required) Parents Names (required) Address Cell Phone Number (required) Your Email (required) Siblings Names Who Will Be Attending Emergency Contacts Doctor's Name Specific Type Of Disability Degree Of Severity Current Medications And Allergies Seizures? YesNo List Any Physical Limitations Please describe your child’s communication abilities Please describe any dietary or feeding needs your child has. Please describe any behaviors that we should be aware of. If behaviors are present what are their triggers? Does your child need help using the restroom? YesNo What activities does your child enjoy the most? Please list any additional info we should be aware of.