Respite Dinner


Join us July 14, 2018 from 5 to 8 p.m.
for a Southwest Dinner!


Guest speaker:
Travis Busch, Summit Community Church, Gorham, Maine


Living Truth Church
8897 Byrom Campbell Road
Pace, FL 32570

Check out our video from the 2017 respite dinner and register for the 2018 dinner below!

Register Now!

 
Name(s) of Parent(s) Attending:
 


 

 
Child with Special Needs:
 

Name:

My child may eat pizza will bring their own food 

Allergies:

Does your child need assistance eating? yes no
Does your child need bathroom assistance? yes no

Please provide a brief description of your child, including special needs:



Siblings: Names:

My child(ren) may eat pizza will bring their own food 

Allergies:

Does your child need assistance eating? yes no
If more than one sibling is listed, please indicate which sibling(s) need(s) assistance:

Does your child need bathroom assistance? yes no
If more than one sibling is listed, please indicate which sibling(s) need(s) assistance:
   
Contact Info:

please enter your phone number

please enter your address

please enter your email address
  


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