Disability Ministry | Complete Registration

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First Name

Last Name

Parent's Email Address

Parent's Phone Number

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DOB:

Mom's Name?

Dad's Name?

Please explain your son or daughter's diagnosis.

My child loves to...

Allergies, please explain

My child's mode of communication:

Verbal

Visual Supports

Sign Language

Digital Communication Devices

Behaviors for us to be aware of

Please list calming tools or supports:

Prone to Seizures:

Toileting Needs, please explain