Totus Tuus for Children with Special Needs 2017
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 31-August 3, 2017 from 10am-2pm at the Spiritual Life Center in Wichita, Kansas.
Child's Name
Your answer
Child's Gender
Child's Age as of July 1, 2017
Your answer
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
Your answer
State
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Zip Code
Your answer
Through what means were you informed of 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?
Your answer
Child's Disability, Social Interaction and Physical Information
Describe your child's disability.
Your answer
Will your child require medication during the time they are attending Totus Tuus (10am-2pm)?
A registered nurse will be present to administer medication.
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
A sack lunch will be provided each day, which includes a ham or turkey sandwich, chips and a cookie. Will this be an acceptable meal for your child? If not, please explain.
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
Additional Information
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 50 children. Checks can be made out to "Catholic Diocese of Wichita" with "Special Needs" in the memo line.
Please visit www.catholicdioceseofwichita.org/faith and click on the "Totus Tuus" tab to fill out the document "Medical Release Form" and send, along with the $50 fee, to:

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

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