Heaven or Bust Retreat

- Evangelization & Outreach

This retreat is planned for all members of the exceptional needs family - dad, mom, siblings, and those with exceptional needs. The day will include sessions for the entire family, sessions for each family member, activities, Adoration, prayer, song & dance, and conclude with Mass. Professional aides will be on hand and ready to serve to ensure a safe and spiritual day.
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- General Information
  
  Family's Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Father's Full Name REQUIRED Please fill out this field. Please enter valid data.
  
  Mother's Full Name REQUIRED Please fill out this field. Please enter valid data.
  
  Please list the names and ages for all of your children. For each child with an exceptionality, please add their information below. REQUIRED Please fill out this field.
  
  Home Parish REQUIRED Please fill out this field. Please enter valid data.
  
  Email REQUIRED Please fill out this field. Please enter an email address.
  
  Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
- Exceptionalities for Child 1
  
  Please tell us more about your child's special/exceptional needs so that we can better support them during this retreat.
  
  Name of Child REQUIRED Please fill out this field. Please enter valid data.
  
  Age of Child REQUIRED Please fill out this field. Please enter valid data.
  
  What is his or her exceptionality? REQUIRED Please fill out this field. Please enter valid data.
  
  What is his or her preferred method of communication? REQUIRED Please fill out this field. Please enter valid data.
  
  Please list all of his or her allergies. REQUIRED Please fill out this field.
  
  Please list all of his or her medical devices. REQUIRED Please fill out this field.
  
  Please list all of his or her strengths. REQUIRED Please fill out this field.
  
  Please list all of his or her interests. REQUIRED Please fill out this field.
  
  Please list all of his or her behavioral difficulties. REQUIRED Please fill out this field.
  
  Please list all of his or her triggers. REQUIRED Please fill out this field.
  
  Please list his or her best forms of behavior intervention. REQUIRED Please fill out this field.
  
  Level of Assistance Needed (Please choose one). REQUIRED Please fill out this field.
  
  Please list any other additional support that might be needed to support this child. REQUIRED Please fill out this field.
- Please list any safety concerns. REQUIRED Please fill out this field.
- Exceptionalities for Child 2
  
  Please tell us more about your child's special/exceptional needs so that we can better support them during this retreat. If you have only one child with special/exceptional needs, please type N/A as your answer to the questions in the section below.
  
  Name of Child REQUIRED Please fill out this field. Please enter valid data.
  
  Age of Child REQUIRED Please fill out this field. Please enter valid data.
  
  What is his or her exceptionality? REQUIRED Please fill out this field. Please enter valid data.
  
  What is his or her preferred method of communication? REQUIRED Please fill out this field. Please enter valid data.
  
  Please list all of his or her allergies. REQUIRED Please fill out this field.
  
  Please list all of his or her medical devices, REQUIRED Please fill out this field.
  
  Please list all of his or her strengths. REQUIRED Please fill out this field.
  
  Please list all of his or her interests. REQUIRED Please fill out this field.
  
  Please list all of his or her behavioral difficulties. REQUIRED Please fill out this field.
  
  Please list all of his or her triggers. REQUIRED Please fill out this field.
  
  Please list his or her best forms of behavior intervention. REQUIRED Please fill out this field.
  
  Level of Assistance Needed (Please choose one). REQUIRED Please fill out this field.
  
  Please list any other additional support that might be needed to support this child. REQUIRED Please fill out this field.
  
  Please list any safety concerns. REQUIRED Please fill out this field.
- Exceptionalities for Child 3+
  
  If you have more than two children with special/exceptional needs, please fill out their information in the below text box using the questions above.
- If you have additional children attending with special requirements (i.e., allergies, safety concerns, etc.), please include this information below including their name.
- Payment
  
  Total Registration Fee per Family25.0
Total:

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