Night To Shine 2025 Guest Registration

Guest Information *

First Name

Last Name

Contact Phone Number:

This will be used if we need to contact you about this registration.

(###)

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Date Of Birth *

MM

DD

YYYY

Gender *

Male

Female

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Emergency Contact During Event (Will be listed on Guest's Nametag) *

First Name

Last Name

Emergency Contact Phone *

(###)

###

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Will Need Medication Administered During Event *

* 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 the medication.

Yes

No