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Autism & Special Needs Registry

  1. Introduction
    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.
  2. Instructions
    Complete the below fields as it pertains to the person with autism and/or special needs.
  3. Instructions
    Complete for the below fields as it pertains to the person completing this form:
  4. Instructions
    Complete the below fields as it relates to a secondary emergency contact (if applicable):
  5. Leave This Blank:

  6. This field is not part of the form submission.