Guestform - Night to Shine - Northern Colorado

Guest Information

Name*

First Last

Preferred name*

Age*

Gender*

Female
Male

Address*

Street Address City State / Province / Region ZIP / Postal Code

Email*

Phone number*

Primary/Emergency contact*

Relationship to guest

Emergency contact phone number*

Do you have any health concerns?*

No
Yes

What are your health concerns?*

Special communication needs?*

No
Yes

Special communication needs*

Do you have any sensory issues or concerns?*

No
Yes

Sensory Issues/Concerns*

(Strobe lights, camera flashes, loud noises, etc.)

Do you have any allergies?*

No
Yes

Please list your allergies*

(Please list any that apply: food, latex, makeup, etc.)

Do you require a therapeutic or specialized diet?*

No
Yes

Dietary requirements*

Please list if you require a therapeutic or specialized diet.

Do you plan to have your hair and makeup done at Timberline Church prior to the event?*

No
Yes

Our team will contact you before the prom to let you know what time to arrive for your hair and makeup appointment. Please watch for an email with your appointment information.

Companion for the Event

Guests will be paired with a volunteer companion at the night of the event.

If you have someone that you want to be your companion, please enter their name below.

Note: This person MUST register as a companion here prior to the event.

Do you have a parent, caregiver or support staff attending the event?*

No
Yes

Parent / Caregiver / Support Staff Information

Parent / Caregiver / Support staff name(s)*

Parent / Caregiver / Support staff phone*

Parent / Caregiver / Support staff email*

Parent / Caregiver / Support staff will be: (select one)*

Dropping guest off
Enjoying Respite Room*
Accompanying as my companion

If you would like to enjoy the respite room, please select that option below. Each guest is limited to 2 people in the respite room. We are working with local restaurants and organizations to get coupons and deals for those who would like to enjoy a night "on the town".

Respite Room Registration

Due to space limitations, registration for the Respite Room is required. 2 parents or caregivers (relative or host home provider) per guest are allowed. Additional family members, children or support staff will not be granted admittance in the Respite Room.

A light, gluten free meal will be served in the Respite Room.

NOTE: In order to monitor the event spaces’ different capacity limits, Respite Room Attendees will not be allowed to freely roam the event, unlike previous years. Exceptions will only be made in the event of an emergency.

A live stream of the dance floor will not be available in the Respite Room. If you wish to accompany your loved one at the event, we recommend registering as their Companion Volunteer.

Special offers are available at area restaurants during the event if you wish to leave and enjoy a meal offsite. Please provide an email address if you would like more details.

How many parents or caregivers will be enjoying the Respite Room?*

1
2

Parent / Caregiver name(s) for check in purposes*

Email for respite room*

Please enter an email for parent / caregiver / support staff to receive info about restaurants

Thank you for registering for the Respite Room! Additional information regarding check in will be emailed to you prior to the event.

Agency Information – If Applicable

Are you attending with an agency?*

No
Yes

Agency*

What is the name of the agency?

Agency phone number*

Agency chaperone*

Section Break

How will you be getting home from the event?*

Additional notes or concerns

Please list any questions, notes, or concerns that you may have.

By registering, you agree to Night to Shine's Participant and Parent/Caretaker Media & Liability Rights Release Forms and Night to Shine's Participant Permission Form:

Participant Media & Liability Rights Release: Media and Liability Rights Release
Parent/Caretaker Media & Liability Rights Release: Media and Liability Rights Release

Media & Liability Rights Releases*

Participant / care provider /agent agrees to the Media & Liability Rights Releases

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Email

This field is for validation purposes and should be left unchanged.