Treasure Coast Night to Shine
About
2020 Photos
Kings & Queens
2024 King & Queen Tickets!
Attendee FAQ
Volunteers
2025 Volunteer Registration
Job Descriptions
Training Video
Volunteer FAQ
Contact
Sponsors
Become a Sponsor
Official TCNTS T-Shirt
Donate
Night to Shine is open to individuals with disabilities ages 14 and up.
Guest Registration Form
As of 1/8/2019-REGISTRATION IS CLOSED
You may still join the wait list by completing the form below and will be notified if an opening becomes available.
*
Indicates required field
Name
*
First
Last
Name as you would like it to appear on name tag:
*
Age/DOB:
*
Gender
*
Male
Female
Phone number
*
Address
*
Line 1
Line 2
City
State
Zip Code
Country
Email
*
Emergency Contact During Event
*
First
Last
Emergency Contact Phone Number
*
Fun Fact About You
*
Health Concerns
*
Wheelchair/Accessibility Device Dependent:
*
Yes
No
Special Communication Needs
*
Yes
No
If Yes, Please Explain
*
Sensory Issues/Concerns (strobe lights, camera flashes, loud noises, etc.):
*
Food Needs (food cut-up or pureed, gluten free, etc.):
*
Yes
No
Alergies
*
(Please list any that apply: foods, animals, latex, makeup, plantsor pollen, etc.)
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 themedication.
Will guest be dropped off and picked up by a parent/caretaker?
*
Yes
No
Will guest be attending as a part of a group that will provide transportation?
*
Yes
No
Parent/Caretaker Information
Name
*
First
Last
Parent/Caretaker will be:
*
Dropping Guest Off
Enjoying Respite Room
If enjoying respite room, how many?
*
Phone Number
*
* 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 Applicable
Care Provider Agency
*
If attending as a part of a group, please include agency or company name
Agency Chaperone(if applicable):
*
First
Last
Phone Number
*
Note: Chaperone is not required to stay with guest(s) unless required by Care Provider Agency.
Additional Notes or Concerns:
*
Submit Form
About
2020 Photos
Kings & Queens
2024 King & Queen Tickets!
Attendee FAQ
Volunteers
2025 Volunteer Registration
Job Descriptions
Training Video
Volunteer FAQ
Contact
Sponsors
Become a Sponsor
Official TCNTS T-Shirt
Donate