Clone of 2025 Christmas Nomination – Shop With a Caregiver

CHRISTMAS LIGHTS RIDE-ALONG REGISTRATION FORM
CHRISTMAS LIGHTS RIDE-ALONG REGISTRATION FORM

Celebrate the holiday season with the Destiny’s Caring Hands LLC Christmas Lights Ride-Along. This free community event gives families the opportunity to enjoy a safe, guided ride through some of the area’s most festive Christmas light displays. Pickup will take place at the St.Joseph, and Elkhart counties for 2025, with additional counties being added next year to give even more households the chance to participate. Registration does not guarantee automatic placement — seats are limited, and a confirmation email will be sent with final pickup time and details. One registration per household.
Section 1: Household Information
Full Name*

First NameLast Name
E-mail*
example@example.com
Phone Number*
Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
County of Residence
Number of People Riding (required – limit 6)
Names and Ages of All Riders (Required)
Section 2: Pickup Preference

Note: Home pickup is not guaranteed. Final pickup instructions will be provided in your confirmation email.
Please select how you would like to be picked up for the Christmas Lights Ride-Along:

I need to be picked up at my home addressI will meet at the Destiny’s Caring Hands LLC office location(220 W. Edison Rd, Mishawaka, IN 46545)
Section 3: How Did You Hear About Us?
How did you hear about this Christmas Lights-Ride along Program?
Section 4: Agreement

Please read and acknowledge the following terms before submitting your nomination:
Please check to acknowledge and agree:

I understand that failure to respond to a confirmation message within the required timeframe may result in forfeiture of the spot.I understand that selected individuals will receive a confirmation email containing instructions, scheduling information, and next steps.I understand that submitting this form does not guarantee a spot on the Christmas Lights Ride-Along.I understand that pickup this year is only at St. Joseph and Elkhart Counties near the Destiny’s Caring Hands LLC office, unless otherwise confirmed. Next year, the other 90 counties will start.I understand that home pickup is not guaranteed and depends on availability, safety, and route scheduling.I understand that all riders must remain seated, buckled (where required), and follow all driver instructions at all times.I agree to treat all Destiny’s Caring Hands LLC staff, volunteers, drivers, and community members with respect.I understand that any disruptive, unsafe, or disrespectful behavior may result in removal from the ride and forfeiture of participation.I understand that Destiny’s Caring Hands LLC cannot guarantee specific light locations, routes, weather conditions, or time extensions.I understand that seats are limited and confirmation is required before arriving for pickup.I understand that every rider must be present at the scheduled pickup time and that being late may result in forfeiture of the ride.I understand that Destiny’s Caring Hands LLC may contact me regarding scheduling, reminders, ride instructions, or future community events.I confirm that all information provided in this form is truthful and accurate.
Photo Consent & Usage

I understand that Destiny’s Caring Hands LLC may take general photos or short videos during the Christmas Lights Ride-Along for documentation and community outreach purposes.I give permission for Destiny’s Caring Hands LLC to use group photos, event images, or non-identifying shots from the Christmas Lights Ride-Along for marketing, website content, social media, and community outreach efforts.I understand that Destiny’s Caring Hands LLC will not sell, misuse, or publish private personal information, and will only use event photos to highlight positive community programs and activities.I understand that no individual close-up photos of me or my family will be used without expressed permission.I understand that participation in the event may include being present in wide-angle, group, or background photos used to promote community engagement.I confirm that I have the legal authority to grant permission for all minors participating with me.
Communication Consent

I understand that Destiny’s Caring Hands LLC may contact me regarding nomination updates, confirmation details, pickup reminders, or future community resource events.
Section 5: Signature & Submission
Signature

Clear
Date
Should be Empty:

CHRISTMAS LIGHTS RIDE-ALONG REGISTRATION FORM

CHRISTMAS LIGHTS RIDE-ALONG REGISTRATION FORM

Section 1: Household Information

Section 2: Pickup Preference

Section 3: How Did You Hear About Us?

Section 4: Agreement

Section 5: Signature & Submission