Night To Shine Participant

Name

This address will receive a confirmation email

Phone

Address

Sex

Male Female

Date Of Birth

Tell Us A Fun Fact About You!

Emergency Contact Name and Phone Number

Are there any health concerns? If no, please mark N/A

Will you have a wheelchair?

Yes No

Are there any special communications needs?

Tell us about any sensory issues (strobe lights, camera flashes, loud noises, etc...)

List all allergies here (please include all that apply: food, makeup, latex, plant/pollen, etc...)

Are there any special food needs? (food cut up, pureed, gluten free, etc...)

Parent/Caretake Name & Phone Number

Parent/Caretake Will Be: (dropping guest off, staying in respite room)

Care Provider Agency Name (if attending as part of a group) - if applicable

Please list any additional notes or concerns here

Description

Friday, February 7th

Night to Shine is an unforgettable prom night experience, centered on God’s love, for people with special needs ages 14 and older. On one night, February 7th, 2025, Spencer Christian Church will join with churches from around the world to host Night to Shine for thousands of honored guests and we want you to be a part of it!

Night To Shine Participant

Description

Please Fix the Following