Night to Shine Registration Waiting List

Honored Guest Information

Guest Name

Name as you would like it to appear on nametag:

Date of Birth

Gender

Male Female

Address

This address will receive a confirmation email

Phone

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:

Yes No

Special communication Needs:

Yes No Other

If you checked other please explain.

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

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):

Yes No

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

Yes No

Will guest be taking public transportation to and from event?

Yes No

Will guest be attending as a part of a group that will provide transportation?

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.

Yes

Parent/Caretaker Information

Parent/Caretaker Name

Parent/Caretaker Phone

Parent/Caretaker will be:

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

February 7, 2020

Night to Shine 2020 is coming up on February 7, 2020 at The Ridge in Meansville, Georgia!
This Registration is FREE!

Every guest of Night to Shine enters this complimentary event on a red carpet complete with a warm welcome from a friendly crowd and paparazzi. Once inside, guests receive the royal treatment, including hair and makeup stations, shoe shining areas, limousine rides, corsages and boutonnieres, a catered dinner, karaoke, prom favors, a dance floor… all leading up to the moment when each guest is crowned king or queen of the prom.

We are looking forward to this night of fun and celebration!

Night to Shine Registration Waiting List

Description

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