Guest Registration Form

Guest Registration Form

Feburary 13, 2026 @ 6:30 p.m. to 9:30 p.m.
SPONSORED BY THE TIM TEBOW FOUNDATION
First Name:
Last Name:
Name as you would like it to appear on nametag
MaleFemale
DOB:
Address:
City:
Zip Code:
Email:
example@example.com
Phone:
Format: (000) 000-0000.
Fun Fact About You:
Emergency Contact during event (will be listed on guest's nametag):
Emergency Contact Phone will be listed on guests nametag:
Format: (000) 000-0000.
YesNo
*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.
YesNo
YesNo
YesNo
We would love to make your Night to Shine experience 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 Concerns:
Mobility Needs:
Communication Needs:
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.)
Additional Notes/ Concerns you would like use to be aware of:
Caretaker Information
Caretaker Names
Caretaker Phone
Format: (000) 000-0000.
Dropping Guest offEnjoying People Room
Caretaker relationship to guest
If enjoying Respite Room*, please list Caretakers.
Name 1
Name 2
* The Respite Room is a private area where caretakers of guests can spend the evening enjoying food, entertainment, and rest while remaining onsite during the event.
Care Provider Agency Information - if Applicable
Care Provider Agency
(If attending as a part of a group, please include agency or company name)
Care Provider Agency Phone
Format: (000) 000-0000.
Agency Chaperone if applicable
Agency Chaperone Cell Phone
Format: (000) 000-0000.
(Note: Chaperone is not required to stay with guest(s) unless required by Care Provider Agency. If Chaperone remains with guest, a current Background Check will be required
Additional Notes or Concerns
Remit form to:

MAIL: Corinth Baptist Church 190 Corinth Road Gaffney, SC 29340

EMAIL: corinthbaptistch@gmail.com

Or SUBMIT: online at www.corinthbaptistgaffney.org
Should be Empty:

Guest Registration Form

Caretaker Information

Care Provider Agency Information - if Applicable