Night to Shine Registration 2026

Please fill out this form and click submit.

Honored Guest Information

Guest Name

Name as you would like it to appear on nametag:

Date of Birth

Gender

Please select one option.

Male Female

Address

Phone

Emergency Contact Information

Emergency Contact During Event (will be listed on guest's nametag):

Emergency Phone Number (will be listed on guest's nametag):

Health Concerns

Wheelchair/Accessibility Device Dependent:

Please select all that apply.

Yes No

Special communication Needs:

Please select all that apply.

Yes No Other

Sensory Issues/Concerns (strobe lights, camera flashes, loud noises, etc.): What Concoles them?

Allergies (Please list any that apply: foods, animals, latex, makeup, plants or pollen, etc.)

Food Needs (food cut-up or pureed, gluten free, dairy free, etc.)

Will Need Medication Administered During Event (Our staff is unable to administer medication. A Parent/Caretaker must administer the medication if necessary):

Please select all that apply.

Yes No

Fun Fact About the Honored Guest:

What is the honored guest's favorite song:

Is there a buddy preference:

Will Guest be dropped off and picked by a parent/caretaker

Please select all that apply.

Yes No

Additional Notes/ Concerns You Would Like Us to Be Aware Of

I understand that my spot for Night to Shine is not guaranteed until approved by staff.

Please select all that apply.

Yes

Parent/Caretaker Information

Parent/Caretaker Name

Parent/Caretaker Phone

Parent/Caretaker will be:

Please select one option.

Dropping Guest Off Enjoying Respite Room

If enjoying Respite Room, how many? * 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. We will broadcast the event in the Respite Room.

Care Provider Agency Information - If Applicable

Care Provider Agency Information (if attending as a part of a group).

Care Provider Agency Phone:

Agency Chaperone (if applicable)

Additional Notes or Concerns:

Description

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Night to Shine Registration 2026

Description

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