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GUEST REGISTRATION FORM

YOU MUST BE 14 YEARS OR OLDER TO BE A GUEST AT NIGHT TO SHINE

Name *
Name
Date of Birth *
Date of Birth
Gender *
Phone *
Phone
Wheel Chair *
List any special concerns we may need to know about including allergies
Buddy *
My Buddy's Name
My Buddy's Name
If you chose to bring your buddy please list their name
Buddy's Phone Number
Buddy's Phone Number
Please list your Buddy's Phone Number
Parent/Caregiver Name *
Parent/Caregiver Name
Parent/Caregiver Phone Number *
Parent/Caregiver Phone Number
You are allowed to bring two guests. Your guests will attend the Parent Room after the Red Carpet.
Person Bringing Registered Guest *
Person Bringing Registered Guest
Person Bringing Registered Guest
Person Bringing Registered Guest
Agreement *
I understand that any pictures taken during Night to Shine may appear on videos, promotional resources, church website, etc. and will be available for public download.