You MUST register to attend as a guest by January 17th.
Name as you would like it to appear on nametag:
Fun Fact About the Honored Guest:
Emergency Contact during event (will be listed on guest’s nametag):
Emergency Contact Phone (will be listed on guest’s nametag):
Wheelchair/Accessibility Device Dependent:
Special Communication Needs:
If yes, please explain:
Sensory Issues/Concerns (strobe lights, camera flashes, loud noises, etc.):
Allergies (Please list any that apply: foods, animals, latex, makeup, plants or pollen, etc.)
Food Needs (food cut-up or pureed, gluten free, dairy free, etc.):
If yes, please explain:
Will Need Medication Administered During Event (Please note that our 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)
Will guest be dropped off and picked up by a parent/caretaker?
Will guest be taking public transportation to and from event?
Will guest be attending as a part of a group that will provide transportation?
For Girls (select all that you need):
Sign up for a fitting to loan a prom dress
Hairstyle by a professional beautician
Limo Ride (short ride around school parking lot)
For Boys (select all that you need):
Sign up for a fitting to loan suit attire
Barber appointment by Texas Made Fades
Limo Ride (Short ride around school parking lot)
Select a Red Carpet Entrance:
Grand Paparazzi Entrance (Red carpet entrance with paparazzi cheering them on, lights, cameras and a lots of noise)
Quiet Entrance (No paparazzi, red carpet, without lights, cameras and loud noise)
Parent/Caretaker will be
Dropping Guest Off
Enjoying Respite Room
If enjoying Respite Room, how many? * The Respite Room is a private area where parents/caretakers of guests can spend the evening enjoying food, entertainment and rest while remaining onsite during the event.
Care Provider Agency (if applicable)
Care Provider Agency Phone:
Agency Chaperone (Chaperone is not required to stay with guest(s) unless required by Care Provider Agency.)
Additional Notes or Concerns:
We ask that guests and parents/caretakers fill out a media release form for this event. By checking this box you agree to completing the media release form below and returning it our team.
Thanks for submitting!
Media Release Form
We ask that guests and parents/caretakers do as well.