Night to Shine Registration

Night to Shine Registration

 Male  
 Female  

 Yes  
 No  

 Yes  
 No  

 Yes  
 No  

 Yes  
 No  

* 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.
 Yes  
 No  

 Yes  
 No  

 Yes  
 No  

Parent/Caretaker Information
 Dropping off  
 Enjoying Respite Room  

* 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)
(Note: Chaperone is not required to stay with guest(s) unless required by Care Provider Agency)
 

* required field