St. Luke 6th-8th Grade Middle School Shine Rally Registration

St. Luke Middle School Shine Rally Registration

Who: 6th-8th Graders
When: Sunday, March 22 | 1pm-6:30pm
Doors open at 12:30pm
Where: 3-Mile Project (Walker, MI)
Cost: $35 / Student (Until noon on Wed. 3/18)
Registrations received by Feb 27 will include a FREE tshirt!
Transportation: Each family is responsible for their own transportation to and from the Shine Rally.
St. Luke's will send a chaperone to meet the group there!

CONTACT: Alex O'Sullivan - Faith Formation Administrative Assistant
Email: ffadmin@lukespot.com

Registration & Payment Deadline: Noon on Wednesday, March 18
Registrations received by Feb 27 will include a FREE tshirt.

Student Name*

First NameLast Name

Student Grade*

Student Gender*

MaleFemale

Student Tshirt Size*

Any medications, known allergies and/or dietary restrictions, or other medical notes.

Parent Name*

First NameLast Name

Parent Email*

example@example.com

Parent Phone Number*

Please enter a valid phone number.

PARENT CHAPERONE NEEDED

Please prayerfully consider chaperoning our group at the Shine Rally! We need adult chaperones to make events like this possible and appreciate your consideration!

I am interested in chaperoning

Please send me more information

Have you completed VIRTUS training?*

Yes.No, but I would be willing to complete the online training.

PARENT PERMISSION FOR YOUTH ACTIVITIES

Your child is eligible to participate in a St. Luke University Parish sponsored activity at 3-Mile Project. Transportation is NOT provided. This activity will take place under the supervision of chaperones from the parish. A brief description of the activity is provided above in the event details section.

Designated Supervisors of Activities: Designated on-site volunteer chaperones.

If you would like your child to participate in this event, please complete, sign, and return the following statement of consent and release of liability by 3/18/2025. As a parent or legal guardian, you remain fully responsible for the actions and conduct of your child.

MEDICAL RELEASE STATEMENT

As a parent/guardian, I do hereby authorize the treatment by a qualified and licensed physician of any condition, which, in the opinion of the physician, is deemed necessary and appropriate. This authority is granted only after a reasonable effort has been made to reach me.

I further authorize the person who presents the minor to sign the Acknowledgement of Receipt of Notice Privacy Rights that may be presented by the physician or health care facility. This authorization is completed and signed of my own free will with the sole purpose of authorizing medical treatment deemed necessary and appropriate by the treating physician.

Reason for which release is intended:*

Middle School Shine Rally on Sunday, March 22, 2026

Consent Statement:*

I agree to the above Parent Permission and Medical Release Statements

Parent Signature*

Emergency Contact Name (NOT A PARENT)*

First NameLast Name

Emergency Contact Relationship to Child*

Emergency Contact Phone Number*

Upon submission of this form, you will be invited to submit a payment on the St. Luke Flocknote payment page. The cost is $35 per student if paid by noon on March 18. Please contact Alex O'Sullivan at ffadmin@stlukegvsu.org to confidentially discuss financial assistance.

You will be redirected to the online payment page upon submission of your child's registration.
Payments can also be made via cash or check.

I agree to submit my child's payment by noon on Wednesday, March 18. If I do not pay by this time/date, I understand that I will need to send my child with $45 for the increased "at the door" entry fee.*

I agree.

Student Info

Parent Info

Parent Permission

Emergency Contact Information (Not a Parent)

Payment Agreement