2026 Erie Night to Shine Guest Registration Form
**Must be 14 years or older to participate in Night to Shine.**
Guest Information
*
First Name
Last Name
Guest Age
*
Guest Date of Birth
*
-
Month
-
Day
Year
Date
Gender
*
Male
Female
Other
Tiara or Crown?
*
Tiara
Crown
Phone Number
*
Please enter a valid phone number.
E-mail Address
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Help us get to know you - share a fun or interesting fact:
We want your Night to Shine experience to be the best it can possibly be. If you are comfortable sharing, please answer any of the following optional items that apply in order to help us offer the best support we can. Health or Behavioral Concerns (write none if there aren't any):
*
Mobility Needs
*
Yes
No
If YES, please explain:
Communication Needs
*
Yes
No
If YES, please explain:
Sensory Issues/Concerns (strobe lights, camera flashes, loud noises, etc.)
*
Yes
No
If YES, please explain:
Allergies (please list any that apply)
*
Yes
No
If YES, please explain:
Food Needs (cut up, pureed, feeding tube etc.)
*
Yes
No
If YES, please explain:
Will you require medication to be administered during the event? PLEASE NOTE: Our 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 caregiver MUST be available to administer the medication.
*
Yes
No
Buddy Choice: Buddies accompany and assist guest throughout the evening, providing companionship and any assistance they may need during the event. (i.e. sit with their guest during dinner, engage with them, ensure they get to all the stations) Volunteer buddies must be at least 18 years old.
*
I will bring my own buddy (please provide information on your buddy in next section).
I will need a buddy assigned.
Buddy Name
First Name
Last Name
Buddy Phone Number
Please enter a valid phone number.
Buddy Email Address
example@example.com
Emergency Contact for Event
Emergency Contact Name
*
First Name
Last Name
Emergency Contact Phone Number
*
Please enter a valid phone number.
Will guest be dropped off and picked up by parent/caregiver?
*
Yes
No
Will guest be taking public transit to and from the event?
*
Yes
No
Will guest be attending as a part of a group that will provide transportation?
*
Yes
No
Parent/Caregiver Information
Parent/Caregiver Name:
*
First Name
Last Name
Parent/Caregiver Phone:
*
-
Area Code
Phone Number
Signature - I give permission for this honored guest to participate in Night to Shine Erie on February 13, 2026.
*
Name of Person Signing (parent / caregiver)
*
First Name
Last Name
Relationship to guest
*
The Respite Party is a separate party (in the same venue) where parents / caregivers of guests can spend the evening enjoying snacks, entertainment and rest while remaining onsite during the event. This is a wonderful opportunity to socialize with others while your honored guest is attending Night to Shine. The limit is 2 Respite Party guests per honored guest. How many will be attending?
*
0
1
2
Name of Person 1 Attending (if applicable)
First Name
Last Name
Name of Person 2 Attending (if applicable)
First Name
Last Name
Care Provider Agency Information--If Applicable
Care Provider Agency
Care Provider Agency Phone Number
-
Area Code
Phone Number
Agency Contact / Chaperone
Agency Contact / Chaperone Phone Number
-
Area Code
Phone Number
Any additional notes or concerns?
Submit Form
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