2027 Night to Shine Participant Registration

Participant's Name (as it should appear on their name tag)

First NameLast Name

Date of Birth

PARTICIPANTS MUST BE AT LEAST 14 YRS OLD (AS OF 2/12/27)

Gender

Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

T-shirts (to secure a shirt, must be registered by Jan 1st)

Name

First NameLast Name

Email (All communications for Night to Shine will go to this email)

example@example.com

Phone Number

Format: (000) 000-0000.

Parent/Caregiver Participation:

Number of adults enjoying the respite room: (If you're registering more than one guest, only give this number once)

Fun facts about the participant:

Please list any participant requested songs for the dance floor!! (Let us know in advance so we can have it ready for your special night! All requests will be reviewed by our DJ.)

Helpful Health Information:

Wheelchair/Accessibility Device Dependent

Special Communication Needs:

Sensory Issues/Concerns: (ie loud noises, strobe lights, camera flashes)

Allergies (Food and Other):

Meal Instructions: (ie food cut-up, pureed, etc)

Please share any other information and/or concerns that we need to be aware of.

Guest will be dropped off and picked up by a parent/caregiver.

Guest will be in the care of a care providing agency or group home.

Agency Name

Name of Care Provider

First NameLast Name

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Please indicate need below

Dress Size

Favorite Color

Shoe Size

Men's Shirt SIze

Neck (in inches)

Sleeve Length (in inches)

Pants Waist (in inches)

Pants Length (in inches)

Shoe Size

2027 Participants Registration Form

Participant's Information

We're so sorry, but attendees must be at least 14 years old for this event. We look forward to welcoming you when you reach 14!

Parent/Caregiver Information

More information for Participant

Care Provider/Agency Information

Formal Wear Assistance

Women's Formal Wear Assistance

Men's Formal Wear Assistance

Confirm Registration