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GUEST REGISTRATION

WE ARE SUPER EXCITED FOR YOU TO JOIN US AT THIS AMAZING EVENT!

The vision for Night to Shine is to provide an unforgettable prom night experience, centered on God’s love, for people with special needs, ages 14 and older.

Night to Shine is:

  • A worldwide movement.

  • Changing Valentine’s Day weekend from simply a celebration of love, to a celebration of God’s love, for people with special needs.

  • An unforgettable prom night experience.

  • A celebration of the value of every life.

  • A night when all guests are kings and queens of the prom.

  • Held simultaneously on one night around the world.

  • Changing the narrative on how people with special needs are viewed.

MEDIA RIGHTS RELEASE

PLEASE FILL OUT THE FOLLOWING REGISTRATION FORM

GUEST INFORMATION
NAME *
NAME
GENDER *
ADDRESS *
ADDRESS
PHONE
PHONE
EMERGENCY CONTACT PHONE (WILL BE LISTED ON GUEST'S NAME TAG) *
EMERGENCY CONTACT PHONE (WILL BE LISTED ON GUEST'S NAME TAG)
WHEELCHAIR/ACCESSIBILITY DEVICE DEPENDENT *
WILL NEED MEDICATION ADMINISTERED DURING THE 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 PARENT/CARETAKER? *
WILL GUEST BE TAKING PUBLIC TRANSPORTATION TO AND FROM THE EVENT? *
WILL GUEST BE ATTENDING AS PART OF A GROUP THAT WILL PROVIDE TRANSPORTATION? *
PARENT/CARETAKER INFORMATION
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.
CARE PROVIDER AGENCY INFORMATION (IF APPLICABLE)
If attending as a part of a group, please include agency or company name
CARE PROVIDER AGENCY PHONE
CARE PROVIDER AGENCY PHONE
Note: Chaperone is not required to stay with guest(s) unless required by Care Provider Agency