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Please complete and submit this form if you have a loved one with autism and/or special needs who lives in the City of West Allis or spends a significant amount of time in the City of West Allis.
Note: We recommend re-submitting this form with updated information on an annual basis. Information that has been on file for more than a year will periodically be purged.
Complete the below fields as it pertains to the person with autism and/or special needs.
Complete for the below fields as it pertains to the person completing this form:
Complete the below fields as it relates to a secondary emergency contact (if applicable):
This field is not part of the form submission.
* indicates a required field