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 have a dress/suit to wear?*

No
Yes

Donated options may be available. Contact [email protected] for more information.

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

No
Yes

Check in for the the Hair & Make Up event is from 4:30pm-5pm at the west main entrance of the church.

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

* The Respite Room is a private area where parents and caregivers of guests can spend the evening enjoying food, entertainment and rest while remaining onsite during the event. Support staff will not be allowed in the Respite Room.

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.

Email

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

1
2

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

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.