Night to Shine Guest Registration

Friday, February 9th from 6pm to 9pm at Ardmore Convention Center

I am registering as: *
only fill in the name if you are coming with a group home as a group.
Guest Name *
Guest Name
Birthdate (must be at least 14 years old) *
Birthdate (must be at least 14 years old)
Gender *
Phone *
Wheelchair *
(Medical, Communication, Sensory, Allergies, Diabetes, etc.)
Buddy *
You must have a Buddy either assigned or brought.
My Buddy's Name
My Buddy's Name
Buddy must also register and attend special training
Parent/Caregiver Name *
Parent/Caregiver Name
Parent/Caregiver Number *
Parent/Caregiver Number
Please list the number of the Parent/Caregiver on the night of the event
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. *
Please check that you have read the above statement