Persons with Disabilities Form

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The Diocese of Toledo is updating our records on families with persons with permanent disabilities to serve and assist them in the formation of their faith, and effectively minister to them. Please take a few minutes to complete the survey below. We greatly appreciate your time and cooperation. If you have more than one residing family member with a permanent disability, please complete a new form for each person. Thank you and God bless.

Your Parish (City, Parish Name) *

Head of Household Last Name *

Head of Household First Name *

Address Line 1 *

Address Line 2

City *

State *

Zip Code *

Your Email Address *

Your Phone Number *

Last Name Person with special needs *

First Name Person with Special needs *

Please state the diagnosis of permanent disability. *

Submit

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