Name: Peace, Love & Prom
Start: 2026-05-02T18:00:00+00:00
End: 2026-05-02T22:00:00+00:00
Location: Hilkert Hall at Saint Ambrose

Guest Information

We invite guests with special needs (aged 16 and up) to be our honored guest and join us for this magical and memorable night.

Guest Name(Required)

First Last

Date of Birth(Required)

Age(Required)

Gender(Required)

Male

Female

Address(Required)

Street Address City State ZIP Code

Emergency Contact

Emergency Contact(Required)

First Last

Emergency Contact Phone Number(Required)

Health Concerns

Does guest require/use a wheelchair?(Required)

Yes

Does guest have special communication needs?(Required)

Yes

Explanation of special communication needs:(Required)

Does guest require direct supervision?(Required)

If yes, a parent/Direct Support Professional is required to stay on the premises in the gym with their guest all night.

Yes

Does guest have sensory challenges/concerns?(Required)

Yes

Examples: Lights, camera flashes, loud noises, etc.

List sensory challenges/concerns:(Required)

Examples: Lights, camera flashes, loud noises, etc.

List any non-food related allergies:(Required)

Examples: latex, plant, pollen, etc. Type N/A if none.

List any food allergies:(Required)

Examples: gluten-free, peanuts, etc. Type N/A if none.

We will be providing a buffet consisting of chicken tenders, macaroni & cheese, mashed potatoes, french-fries, mini-sandwiches, pizza, fruit cups, pudding, jello, ice-cream, etc.

If there are specific dietary restrictions (such as pureed, mechanical diet, etc.), the Direct Support Professional will need to make these accommodations for their guest (food will be provided).

Additional Notes/Concerns:

What is one of your guest’s favorite things to do?(Required)

Parent/Direct Support Professional Information

Parent/Direct Support Professional Name(Required)

First Last

Parent/Direct Support Professional Phone(Required)

Parent/Direct Support Professional Email(Required)

Parent/Direct Support Professionals will be:(Required)

Check all that apply.

Dropping guest off.

Enjoying the parent respite room (parents only, please).

Staying at the Prom in Hilkert Hall/Gym with your guest all evening.

Number of parents attending Respite Room:(Required)

Please RSVP for all parents staying in Respite Room.

Names of parents attending Respite Room:(Required)

First Name

Last Name

Use + to add more names.

Number of guests staying at the Prom in Hilkert Hall/Gym with your guest all evening:(Required)

Please RSVP for all parents/DSP staying at the Prom in Hilkert Hall/Gym with your guest all evening.

Names of guests staying at the Prom with your guest:(Required)

First Name

Last Name

Use + to add more names.

The parent respite room will be in a separate room (in the same building) as the Prom. Parents can spend the evening enjoying a delicious dinner, appetizers and desserts and rest while remaining onsite during the event.

All Direct Support Professionals that are required to stay with their guest will be seated at their guest’s table in the gym. Dinner will be provided for the Direct Support Professional as well.

Care Provider Agency Information (if applicable)

Care Provider Agency

Care Provider Phone

Agency Chaperone Name (if applicable)

First Last

Additional Notes/Concerns:

Questions or Concerns? Contact Jennie Porco at JPorco@StAmbrose.us or 330.460.7317 for additional information or questions.

Payment

Guest Tickets (Required)

Honored guest with special needs (aged 16 and up).

Price: $25.00

Parents in Respite Room (Required)

Parents do not need a ticket, but must RSVP.

Price: $0.00

Direct Support Professionals (Required)

Direct Support Professionals staying with guests throughout the evening in Prom.

Price: $0.00

Total

Credit Card(Required)

American Express

Discover

MasterCard

Visa

Card Number

Expiration Date

Security Code Cardholder Name

CAPTCHA

Details

Venue

Guest Information

Emergency Contact

Health Concerns

Parent/Direct Support Professional Information

Care Provider Agency Information (if applicable)

Payment

Peace, Love & Prom

Join us at Peace, Love, & Prom!

Saturday, May 2, 2026 | 6:00 pm – 10:00 pm

Are you interested in volunteering?

Details

Venue

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