Guest Application

Night to Shine Logo (1).jpg
Name *
Name
Name as you would like it to appear on name tag:
Name as you would like it to appear on name tag:
Date of Birth *
Date of Birth
Gender *
Address *
Address
Phone *
Phone
Emergency Contact
Emergency contact during event *
Emergency contact during event
Emergency Contact phone *
Emergency Contact phone
Wheelchair/Accessibility Device
Special Communication Needs
Will Need Medication Administered During Event *
* Please note that the church, their staff and volunteers are not responsible for administering medication to guests during the Night to Shine event. If medication is required during the event, a parent or caretaker MUST be available to administer the medication.
Will guest be dropped off and picked up by a parent/caretaker?
Will guest be attending as a part of a group that will provide transportation? *
Parent/Caretaker Name *
Parent/Caretaker Name
Parent/Caretaker Phone *
Parent/Caretaker Phone
Parent/Caretaker will be
The Respite Room is a private area where parents/caretakers of guests can spend the evening enjoying food, entertainment and rest while remaining onsite during the event.
Participant Name *
Participant Name
Parent/Caretaker Name
Parent/Caretaker Name
Date
Date
Full name: By typing your full name you certify this as a digital signature (if over age 18)
Full name: By typing your full name you certify this as a digital signature (if participant is under age 18)
Address
Address
Phone
Phone