Totus Tuus for Children with Special Needs 2019
These four days of Totus Tuus are for children ages 6-13 who have an IEP that places them outside of the self contained classroom for the majority of the school day. The program will be held from July 29-August 1, 2019 from 10am-2pm at the Spiritual Life Center in Wichita, Kansas.
Child's Name *
Your answer
Child's Gender *
Child's Date of Birth *
Your answer
Has your child made their First Holy Communion? *
Does your child receive Communion weekly? *
Parish *
Your answer
Diocese *
Your answer
Child's T-Shirt Size *
Parent/Guardian Name(s) *
Your answer
Email Address *
Your answer
Confirm Email Address *
Your answer
Phone Number *
Your answer
2nd Phone Number *
Your answer
Home Address *
Your answer
City, State, Zip Code *
Your answer
How did you hear about Totus Tuus for Children with Special Needs? *
Please check all that apply
Required
Child's Interests
How does your child learn best? *
Touching items, seeing visuals, listening to someone speak, listening to music, watching videos, doing crafts, etc.
Your answer
Is there any particular thing that your child is interested in? Please feel free to send these items, if appropriate *
Your answer
Child's Disability, Social Interaction and Physical Information
Will your child require medication during the time they are attending Totus Tuus (10am-2pm)? *
Please check any of the following that are a challege for your child. *
Required
If your child experiences emotional or behavioral difficulties, what kinds of support work best in restoring a sense of calm? *
Your answer
Does your child have allergies? If yes, to what? *
Your answer
Does your child require special positioning in a wheelchair? If yes, please explain. *
Your answer
Does your child wear AFOs, prosthetics or braces? If yes, please explain. *
Your answer
Does your child have seizures? If yes, please describe frequency and describe any visible warning signs. *
Your answer
Does your child require any special dietary needs or restrictions? *
Your answer
Does your child have any food allergies/issues? *
Your answer
Child's Personal Hygiene and Toileting Needs
Does your child need assistance with any of the following: *
Required
If any of the above are required, please explain. *
Your answer
Next Steps:
We look forward to serving your child through the Totus Tuus program! Please remember that there is a $50 fee to reserve a spot for your child and space is limited to 20 children. Checks can be made out to "Catholic Diocese of Wichita" with "Special Needs" in the memo line.

Totus Tuus - Special Needs
Catholic Diocese of Wichita
424 N. Broadway
Wichita, KS 67202

Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.