Agency Registration Form 2025

Night to Shine Goldsboro Agency Honored Guest Registration
Goldsboro Night to Shine is February 13th, 2026. Please save this date on your calendar.

****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.***

***Forms must be submitted by December 1st, 2025 at 5:00 PM. If forms are received after this date, they will be placed on the waiting list. Confirmation of receipt of forms and acceptance will be emailed to the person completing the form***

If you need any additional information, contact
Donna Countryman
First Baptist Church Goldsboro
125 S John Street, Goldsboro NC 27534
919-735-2516
NTS2024Prom@gmail.com
Agency Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.
Email
example@example.com
Agency Contact Name

First NameLast Name
Would you like to receive information via text

YesNo

Honored Guest Registration
How many honored guests would you like to register

Honored Guest 1 Name

First NameLast Name
Gender

MaleFemale
Date of Birth

MonthDayYear
Date
Important Information (Ambulatory, food needs, wheelchair, etc)
Buddy Assigned

Honored Guest 2 Name

First NameLast Name
Gender

MaleFemale
Date of Birth

MonthDayYear
Date
Important Information (Ambulatory, food needs, wheelchair, etc)
Buddy Assigned

Honored Guest 3 Name

First NameLast Name
Gender

MaleFemale
Date of Birth

MonthDayYear
Date
Important Information (Ambulatory, food needs, wheelchair, etc)
Buddy Assigned

Honored Guest 4 Name

First NameLast Name
Gender

MaleFemale
Date of Birth

MonthDayYear
Date
Important Information (Ambulatory, food needs, wheelchair, etc)
Buddy Assigned

Honored Guest 5 Name

First NameLast Name
Gender

MaleFemale
Date of Birth

MonthDayYear
Date
Important Information (Ambulatory, food needs, wheelchair, etc)
Buddy Assigned

Honored Guest 6 Name

First NameLast Name
Gender

MaleFemale
Date of Birth

MonthDayYear
Date
Important Information (Ambulatory, food needs, wheelchair, etc)
Buddy Assigned

Honored Guest 7 Name

First NameLast Name
Gender

MaleFemale
Date of Birth

MonthDayYear
Date
Important Information (Ambulatory, food needs, wheelchair, etc)
Buddy Assigned

Honored Guest 8 Name

First NameLast Name
Gender

MaleFemale
Date of Birth

MonthDayYear
Date
Important Information (Ambulatory, food needs, wheelchair, etc)
Buddy Assigned

Honored Guest 9 Name

First NameLast Name
Gender

MaleFemale
Date of Birth

MonthDayYear
Date
Important Information (Ambulatory, food needs, wheelchair, etc)
Buddy Assigned

Honored Guest 10 Name

First NameLast Name
Gender

MaleFemale
Date of Birth

MonthDayYear
Date
Important Information (Ambulatory, food needs, wheelchair, etc)
Buddy Assigned

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