Participant registrationRegister for 2023 NOCO Night to Shine!To register as a participant, please fill out the form below.Guest InformationName* First Last Preferred name*Age*Gender*FemaleMaleAddress* Street Address City State / Province / Region ZIP / Postal Code Email* Phone number*Primary/Emergency contact*Relationship to guestEmergency contact phone number*Do you have any health concerns?*NoYesWhat are your health concerns?*Special communication needs?*NoYesSpecial communication needs*Do you have any sensory issues or concerns?*NoYesSensory Issues/Concerns*(Strobe lights, camera flashes, loud noises, etc.)Do you have any allergies?*NoYesPlease list your allergies*(Please list any that apply: food, latex, makeup, etc.)Do you require a therapeutic or specialized diet?*NoYesDietary 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?*NoYesOur 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 EventGuests 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?*NoYesParent / Caregiver / Support Staff InformationParent / 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 offAccompanying as my companionPlease note - our respite room is now full. If you would like to join the waiting list, please email info@noconighttoshine.com.Respite Room RegistrationDue 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?*12Parent / Caregiver name(s) for check in purposes*Email for respite room*Please enter an email for parent / caregiver / support staff to receive info about restaurantsThank you for registering for the Respite Room! Additional information regarding check in will be emailed to you prior to the event.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 ApplicableAre you attending with an agency?*NoYesAgency*What is the name of the agency?Agency phone number*Agency chaperone*Section BreakHow will you be getting home from the event?*Please select one.Getting picked up at the eventMy caregiver will be attending the event (in the respite room)I am driving myselfAdditional notes or concernsPlease 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 ReleaseMedia & Liability Rights Releases* Participant / care provider /agent agrees to the Media & Liability Rights ReleasesCAPTCHANameThis field is for validation purposes and should be left unchanged.ΔHave a question or want more information? Visit our FAQ page or contact us with your questions. Go to the FAQ pageContact us