SHINE's Got Talent Show Registration Form
Thank you for registering for SHINE’s Got Talent, a all ability inclusive talent show celebrating children and individuals with autism and special needs! Please complete the form below to secure your spot.
Please note one sibling, parent, or caretaker assisting the performer on stage will receive free admission!
Performances are limited to 4 minutes max
Participants are to arrive at 2pm!
**Disclaimer**
All performances must be family-friendly. No explicit lyrics, raunchy music, or inappropriate content allowed.
Name of Participant
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First Name
Last Name
Date of birth of participant
*
-
Month
-
Day
Year
Date
Gender of participant
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Male
Female
Other
Will you need background music?
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Yes
No
Does the performer need a buddy to assist them on stage, or will a parent/caretaker be providing support?
*
Buddy
Parent
Sibling
Does not need assistance
I need a volunteer to help
Please provide the name of the parent/caretaker/sibling that will be assisting the performer
*
Will you need background music? If Yes, please provide song title & artist
*
**Disclaimer:** All performances must be family-friendly. No explicit lyrics, raunchy music, or inappropriate content allowed.
Description of the participant's performance and any props needed
*
Participants are responsible for bringing their own props
Performance Title (if applicable)
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Name of Parent/Guardian
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First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Please list your county
*
Emergency Contact (1)
*
First Name
Last Name
Emergency Contact Phone Number (1)
*
Please enter a valid phone number.
Format: (000) 000-0000.
Emergency Contact (2)
*
First Name
Last Name
Emergency Contact Phone Number (2)
*
Please enter a valid phone number.
Format: (000) 000-0000.
Media Release, Consent & Liability WaiverBy registering for this event, you acknowledge that: SHINE and its affiliates are not liable for any injuries, accidents, or lost/stolen items during the event. If accommodations are needed, SHINE will do its best to provide them within available resources.SHINE reserves the right to use event photos/videos for promotional purposes. By signing below, I confirm that I have read and agree to these terms.
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Submit
Submit
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