Guest Registration Form
Fill out the Honored Guest form for Night to Shine 2023, our team will get back with you as soon as possible.
Full Name
*
First Name
Last Name
Age as of 2/10/23
Gender:
*
Female
Male
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
E-mail
*
example@example.com
Phone Number
*
Fun Fact About You:
Primary Contact Name:
*
Primary Email:
*
example@example.com
Primary Phone Number:
*
Please enter a valid phone number.
Health Concerns: *If none, enter N/A.
*
Special Communication Needs: *If none, enter N/A.
*
Sensory Issues/Concerns (strobe lights, camera flashes, loud noises, etc.):*If none, enter N/A.
*
Red Carpet Type:
*
Red Carpet with Paparazzi
Red Carpet without Paparazzi for Sensory Sensitive Guest
Allergies (Please list any that apply: food, animals, latex, makeup, plants or pollen, etc.):
By checking the box, you confirm you will sign the media release form (at nighttoshinevictoria.com/guest). There will be photographers and videographers at this event!
*
I confirm
By checking this box, I understand that group homes will arrive at 5:30 pm and individual Honored Guests will arrive between 6 - 6:30 pm.
*
I confirm
Will you need prom attire?
*
By checking this box, you confirm you will need prom attire provided by Riverside Church.
No sign up please
Girls Hair and Make Up:
*
I want to sign up for my hair and make up to be done. By checking this box, you understand that someone will be in contact with you to setup a time with you.
No sign up please
Guys Hair:
*
I want to sign up for my hair to be cut. By checking this box, you understand that someone will be in contact with you to setup a time with you.
No sign up please
Group Home Information
Group homes will arrive at 5:30 pm.
Is the Honored Guest a part of a group home?
*
Yes
No
Group Home Staff Name:
Staff Phone Number:
Please enter a valid phone number.
Group Home Address:
Parent/Caretaker Information
***There will be a Parent/Guardian Info Meeting (February 4,2023 from 1-2pm)
Parent/Caretaker Name(s):
*
Parent/Caretaker Phone:
*
Will you be joining other caretakers in the Respite room? (There will be a catered meal, door prizes, games, and 10 minute massages available).
*
Yes
No
If so, how many family members will be joining you?
All honored guests will be checked out by Care Giver / Parent at the main entrance door. Please let us know if you are unable to get out of vehicle; we will walk guest out if needed.
I'm unable to exit my vehicle.
I will check out my Honored Guest.
Care Provider Agency information - If Applicable
Care Provider Agency:
Care Provider Agency Phone:
Agency Chaperone (if applicable):
Do you have additional questions or have a prayer request?
Submit Form
Should be Empty: