Night To Shine Guest Registration 2023 Night to Shine 2023 will take place on Friday February 10, 2023 at CrossPointe Church from 6pm-9pm. Register below to reserve your spot. Name First Last Name as you would like it to appear on nametag:* Age/DOB:* Gender:* Female Male Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code County* Email* Phone*Military Family?NoYesFun Fact About You: What size T-Shirt does the Guest wear?*SmallMediumLargeX-LargeXX-LargeXXX-LargeXXXX-LargeEmergency Contact During Event* Emergency Contact Phone:*Health Concerns:Wheelchair/Accessibility Device Dependant:* Yes No Special Communication Needs* No Yes If yes, please explain:Sensory Issues/Concernsstrobe lights, camera flashes, loud noises, etc.Allergies:* Please list any that apply: foods, animals, latex, makeup, plants or pollen, etc.Food Needs (food cut-up or pureed, gluten free, etc.)* No Yes If any advanced feeding help is needed the caregiver will need to stay on the premise to help with this process.If yes, please explain:Will Need Medication Administered During Event: Yes No *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.Will Guest be dropped off and picked up by a parent/caretaker?* Yes No Will guest be taking public transportation to and from event?* Yes No Will guest be attending as a part of a group that will provide transportation?* Yes No Is the guest attending a part of a group home?* Yes No If yes, please tell us the group you will be arriving with:Parent/Caretaker InformationParent/Caretaker Name* First Last Parent/Caretaker Phone*Parent/Caretaker will be... Dropping Guest Off: Enjoying Respite Room If enjoying Respite Room, how many? *The Respite Room is a private area where parents/caretakers of guests can spend the evening enjoying food, entertainment and rest while remaining onsite during the event.Care Provider Agency Information-If ApplicableCare Provider Agency: If attending as a part of a group, please include agency or company nameCare Provider Agency PhoneAgency Chaperone Name (If applicable): First Last Note: Chaperone is not required to stay with guest(s) unless required by Care Provider AgencyAdditional Notes or Concerns: