Special Needs Sacramental Registration Contact PersonContact information for the person filling out this form.Name(Required) First Last Email(Required) Enter Email Confirm Email PhoneRelationship to the sacramental candidate:(Required)ParentLegal GuardianFriendCaretakerOtherCandidate DetailsInformation about the candidate seeking the sacraments.Name(Required) First Middle Last Email(Required) Phone(Required)Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Gender(Required)MaleFemaleAge(Required)What condition best describes the candidate's special needs?(Required) Autism Spectrum Disorder Down Syndrome Cerebral Palsy Muscular Dystrophy Traumatic Brain Injury Other Please briefly list other conditions:What sacrament(s) has the candidate already had?(Required) Baptism Reconciliation (Confession) Holy Communion Confirmation None What sacrament(s) is the candidate seeking to complete?(Required) Baptism Reconciliation (Confession) Holy Communion Confirmation Select all the character traits that apply to the candidate:(Required) Nonverbal Hyperactive Wheelchair (or other mobility aid) user Speech Difficulties Limited Motor Skills Trouble Focusing Other Please briefly list other traits: Δ
