If there is no answer, type "None" in the fields
             
            
                
                
            
            
                
                
            
            
                
                
            
            
                * 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.
             
            
                
                
            
            
                
                
            
            
                
                
            
            
                
                
            
            
                
                
            
            
                
                    
                    
                
                
                    
                    
                
             
            
                
                
            
            
                If enjoying Respite Room, please limit to 2 Parents or Caregivers
             
            
                
                
            
            
                
                
            
            
                *The Respite Room is a private area where parents/caretakers of guests can spend the evening enjoying food, entertainment, activities, and rest while remaining onsite during Night to Shine.
             
            
                Care Provider/Group Agency Information
             
            
                
                
            
            
                
                
            
            
                
                
            
            
                
                
            
            
                
                
            
            
                Media & Liability Release:
             
        
            
                
                
            
            
                
                
            
            
                Please review for errors before submitting this form.