NIGHT TO SHINE REGISTRATION

February 7, 2025 @ 6PM | Please fill out this form and click submit.

HONORED GUESTS INFORMATION

Guests Name

*

Date of Birth

*

Gender

*

Please select all that apply.

Male Female

T-Shirt Size

*

Please select one option.

Adult Small Adult Medium Adult Large Adult X-Large Adult XX-Large Adult XXX-Large

CARE TAKERS INFORMATION

Care Takers Name

*

Email

*

This address will receive a confirmation email

Phone

*

Please include both a mailing address and a physical address if different

Mailing Address

*

Physical Address

Will there be a parent or caregiver present for the duration of the event

*

Please select all that apply.

Yes No

Is the Honored Guest under state guardianship? If so, check the box so he/she will be identified as such to prevent photography and/or photo sharing.

*

Please select all that apply.

Yes No

Emergency Contact for the night of the event

Phone Number of emergency contact

Is the Honored guest checking in as an individual or part of a group?

*

Please select one option.

Individual Part of a Group

If checking in with a group please explain.

Additional Notes or concerns

CONSENT

*

Please select one option.

By completing this application you/your guardian consent to have photos and/or videos taken during the event and potentially used for social media and film productions for future Night to Shine eventson

Description

February 7, 2025 @ 6PM

Please fill out this form and click submit.

Please Fix the Following

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