Participant Registration

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St. Luke's Church

Location

900 Maryvale Dr

Cheektowaga, NY 14225

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Contact Anne Schultz & Michelle Silverblatt:

716-633-6752

stlukebuffalokids@gmail.com

First, Tell Us About Yourself:

Parent Information

If a second parent lives at a separate address and may be picking up your child, please add their information below under "Pick Up"

First Name

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Last Name

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Address 1

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Address 2

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City

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State/Province

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ZIP/Postal Code

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Text Message Phone

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If you're not the parent/guardian: Your name & relationship to child being registered

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Emergency Contact Name

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Emergency Contact Relationship

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Emergency Contact Phone

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Home Church Affiliation

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Comments

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Pick Up: For *EVERY* person who has permission to pick up your child from VBS, including emergency contact, provide **FULL NAME, ADDRESS, and PHONE NUMBER** (photo ID is checked at dismissal). Please separate contacts/lines with a period or space instead of the enter/return key :)

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Where did you hear about our VBS program?

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I have read and agree to the Parent Acknowledgement terms (found under Documents)

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Please check here if you may be interested in helping with prep work/decorations or during VBS (note that we have mandatory safety requirements for any volunteers working with children, including a background check and training)

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Click here for your FREE Friends With God Kids Activity Pack

By checking the box you will be emailed your Free Friends With God Kids Activity Pack.

You are also agreeing to receive emails about family resources from Lifetree. You can unsubscribe at any time. We value your privacy. Your information will not be shared with a third party. Lifetree is a division of Group Publishing, the creators of Group VBS and other faith-building resources. Click to learn more about Lifetree.

Tell Us About Your Participant

First Name

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Last Name

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Grade Leaving

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Gender

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Date Of Birth

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Age at VBS

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Does your child have any *food* allergies? If yes, please complete and submit our food allergy form (under Documents) to ensure that their needs are met.

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If your child has any medical condition or behavioral/cognitive needs or diagnosis that our volunteers should be aware of during VBS (ex. bee sting allergy, latex allergy, autism, ODD, Insulin Dependent Diabetes, ADHD): Please list all relevant diagnoses, and any supplies they require to have on site (ex. epipen, insulin, inhaler). Child must be able to self carry and administer when appropriate.

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Please list any relevant support services your child receives in their classroom during the school year (ex. speech therapy, OT, ENL, academic support). We ask to make us aware of extra attention they may need.

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Is there anything you can share with us about your child that will help us to ensure that they enjoy their week at VBS? (ex. strengths and interests, support needed for sensory issues, difficulty with transitions, anxiety, behaviors that could affect the participation of your child or their peers, etc.)

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If your child was invited by a friend attending this VBS, please enter the friend’s full name here (to enter him/her for a prize raffle!)

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Comments

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