Honored Guest

Guest Information

First Name

Last Name

Mobile

Gender

Birthday

/ /

Address

Guest's Printed Name tag Details

Name as you would like it to appear on nametag

Fun Fact About You

Emergency Contact #1 First and Last Name

Emergency Contact #1 Phone Number

Guest's Medical Information

Health Concerns

Wheelchair/Accessibility Device Dependent

Special Communication Needs

No Yes

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, nut free, etc.)

Will Need Medication Administered During Event

No Yes

* 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.

Logistic information

Check out procedures

Guest will be picked up and dropped off by a parent/caretaker who will be staying for the event Guest will be picked up and dropped off by a parent/caretaker who will not be staying at the event Guest will be attending as part of a group with an agency Guest will be taking public transportation to and from the event Guest will be driving themselves to and from the event.

Friend for the evening request

The guest would like Vox to provide a friend for the evening. Parent(s)/Caretaker(s) will enjoy the respite room. The guest would like a parent/caretaker to be their friend for the evening. Vox need not provide a friend for the evening. The guest would like a parent/caretaker to accompany them AND Vox to provide a friend for the evening.

Media Release

By selecting 'Yes', I grant my permission to Vox Church to use, in whole or in part, photographs, videos, written extractions and voice recordings of the honored guest at the 2024 Night to Shine Branford for the purpose of Vox Church's social media, websites, blogs, email blasts, publications, advertising, promotional and marketing materials, and public relations efforts.

Media Release:

No Yes

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

Night to Shine Guest Registration 2025

Honored Guest

Guest Information

Guest's Printed Name tag Details

Guest's Medical Information

Logistic information

Media Release