Light Up the Night Registration Form ✨🌟

Light Up the Night Registration Form ✨🌟

Please fill out this form to register for the dance event and provide any support or medical information needed. Light up the Night will be held on Saturday, September 12th. Please follow us on Facebook for all updates and important information! There is a $25 NON-REFUNDABLE registration fee link at the end of the form that is due on registration!
Participant Name

First NameLast Name
Age
Parent/Support Person/Guardian

First NameLast Name
Email Address
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
T-Shirt Size
Will you need a buddy during the event?
If yes, please describe the support your buddy can give you?
What would make a good buddy for me?
Will you be bringing your own support staff, family member, or caregiver?
Do you have any accessibility accommodations we should be aware of?

Other (please explain)
Are there any medical concerns, allergies, or emergency information we should know about?
Emergency Contact Name (This person must be available to reach)

First NameLast Name
Emergency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
How did you hear about Light Up the Night?
What are you most excited about for the event?
Photo Release Authorization
By attending and/or participating in the Light Up the Night event, I acknowledge and understand that participation in this event involves inherent risks, including but not limited to personal injury, illness, property damage, accidents, and other unforeseen hazards.I voluntarily assume all risks associated with attending and participating in this event and agree to do so at my own risk.To the fullest extent permitted by law, I hereby release, waive, discharge, and hold harmless The Arc of Norfolk, The Arc of Norfolk Board of Directors, Light Up the Night, WarHorse, all event sponsors, volunteers, employees, officers, directors, agents, representatives, and affiliated organizations from any and all claims, demands, causes of action, damages, losses, liabilities, costs, or expenses arising out of or related to my attendance or participation in the event, including those resulting from accidents, injuries, or property damage.By attending this event, I acknowledge that I have read and understand this release and voluntarily agree to its terms.ATTEND AT YOUR OWN RISK.
Additional Comments or Information We Should Know
Fun Facts about me (list at least three)
Song Choice
What might scary me
By Signing below, you accept the above information is true and correct, and have read and understand the releases.
Will you want your hair, makeup, nails done?

My Products

Registration Fee

$25.00 Quantity

Total

Debit or Credit Card
Credit Card Number	Security Code
Expiration Month	Expiration Year

Should be Empty: