Night To Shine Guest Registration
Night to Shine is an unforgettable prom night experience, centered on God’s love, for people with special needs 14 years and older. We will serve as one of the more than 500 churches around the world hosting a Night to Shine simultaneously on Friday, February 9, 2018.
Participating Guest Information
Guest First Name
Guest Last Name
Name as you would like it to appear on nametag
Date of Birth (mm/dd/yy)
Fun Fact About Guest
Emergency Contact Name
Emergency Phone #
Guests Special Support
We want to work with you to provide an amazing experience. Please share needs/concerns and how issues are successfully accommodated.
Special Communication Needs
Consider this event is a prom which involves crowds, strobe lights, camera flashes and loud noises.
Consider food, animals, latex, make-up, plants, pollen, etc.
Special Food Needs
Please list any dietary restrictions or special food preparation required.
Will Guest Attend in Wheelchair?
Tell us how we can help
Let us know if you might need or want any of the following:
Hair Styling (Male or Female)
Prom Attire Needs
Guest Needs Attire Assistance
No Attire Assistance Needed
If attire is needed, please list sizes
A buddy accompanies and assists a guest throughout the evening. They will provide companionship and any assistance they may need during the event; including sitting with their guest during dinner and engaging with them in conversation.
Choose a Buddy Option
There are no special conditions that require a specific caregiver. I want the Night to Shine team to provide a buddy.
Due to special conditions, I will provide a guest specific buddy who will remain with my guest the entire night.
Please provide the following information if you are providing a guest specific buddy.
Buddy's Full Name
Buddy Date of Birth
Buddy Phone #
Buddy Relation to Guest
Parent/Caretaker Phone #
Will Parent/Caretaker(s) attend Respite Room?
The respite room is a place near the prom for parents and caretakers to relax, enjoy refreshments and the company of others while the Night to Shine guests enjoy the dance.
# in Respite Room
Care Provider Agency Information - If Applicable
Care Provider Agency
Care Agency Phone #
Care Agency e-mail
Agency Chaperone (If Required by Agency)
Send me a copy of my responses
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