Supplemental Needs Form
Name
First Name
Last Name
Email
example@example.com
Best Emergency Phone
Please enter a valid phone number.
Secondary Phone Number
Please enter a valid phone number.
Please describe, as specifically as possible, any special needs or learning differences of your child that may impact his/her full participation in our parish religious education program:
Does your child have an IEP or similar educational plan in place? If so, what accommodations are recommended?
Any additional information or comments?
I understand that the above information may be shared with volunteer catechists and program personnel when it is necessary and in the best interest of my child. I understand that the parish will attempt to provide reasonable accommodations for each child, given the parish facilities and staffing abilities, and that when requested accommodations cannot be provided by this parish, an attempt will be made to refer the family to other programs or resources.
I understand
Parent/Guardian Signature
Date
-
Month
-
Day
Year
Date
Submit
Should be Empty: