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Welcome

We are so excited to have your guest attend our 2019 Night to Shine! This year’s NTS is going to be an amazing night of fun and joy for all.

Please take a moment to fill out the following attendee form.

NTS 2019 Guest Registration Form:

Guest Name *
Guest Name
First and Last Name
Name Prefered on Name Tag
Name Prefered on Name Tag
Guest Cell #
Guest Cell #
Guest Home #
Guest Home #
Guardian Address *
Guardian Address
Guest Gender *
Wheelchair *
If Yes, please explain.
Date of Last Seizure?
Date of Last Seizure?
Leave blank if N/A.
If Yes, please explain.
If Yes, please explain.
If Non-Verbal please explain.
Uses ASL? *
Allergy concerns we should be aware of?
Any food sensitivities we should be aware of?
Are certain foods required?
Please list all current medications.
If yes, please explain.
Anxiety concerns we should be aware of?
What are some of the guests hobbies or pastimes?
Topics we should avoid?
Would the guest like a dress or suit? *
Buddy *
Would your guest be more comfortable with a male or female buddy?
Will your guest be attending with another guest? Are they registered?
Parent/Caretaker Name *
Parent/Caretaker Name
Parent/Caretaker Phone # *
Parent/Caretaker Phone #
Other than Parent/Caretaker listed above.
Emergency Contact # *
Emergency Contact #
Emergency Contact # other than Parent/Caretaker listed above.
Parent/Caretaker will stay on-site in the Respite Room. *
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.
Number of guests staying in Respite Room. *
How many parent/caretaker guests will use the Respite Room?
Respite Room Guest #1 Name
Respite Room Guest #1 Name
Name of 1st Parent/Caretaker staying in the Respite Room during the event.
Respite Room Guest #2 Name
Respite Room Guest #2 Name
Name of 2nd Parent/Caretaker staying in the Respite Room during the event.
Is guest associated with a Care Provider? *
Yes/No