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Participant Registration Form

Guest Information
Wheelchair/Accessibility Device Dependent
Special Communication Needs
Food Needs (food cut-up or pureed, gluten free, dairy free, nut free, etc.)
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 medication.
Will guest be dropped off and picked up by a parent/caretaker?
Will guest be taking public transportation to and from event?
Will guest be attending as a part of a group that will provide transportation?
Parent/Caretaker Information
Parent/Caretaker will be...
If enjoying Respite Room, please limit to two Parents or Caretakers.
* 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.
Note: Chaperone is not required to stay with guest(s) unless required by Care Provider Agency.  If Chaperone remains with guest, a Background Check will be required.

Thank you for registering for Night To Shine. See you there!

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