Night To Shine 2021 Guest Registration
Please complete and submit to register as our guest for the Night to Shine event.
Name
Date of Birth
Gender
Please select all that apply.
Male
Female
Address
--
AA
AB
AE
AK
AL
AP
AR
AS
AZ
BC
CA
CO
CT
DC
DE
FL
FM
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MB
MD
ME
MH
MI
MN
MO
MP
MS
MT
NB
NC
ND
NE
NH
NJ
NL
NM
NS
NT
NU
NV
NY
OH
OK
ON
OR
PA
PE
PR
PW
QC
RI
SC
SD
SK
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
YT
Email
This address will receive a confirmation email
Phone
*** Please note all further information and the link to the virtual event will be sent to the email address you provide.
Primary Contact Name During Virtual Event
Contact Phone
Is Location During Event The Same As Above? (Used For NTS Parade Route)
Please select one option.
Yes
No
Select Option
Yes
No
If No, List Location Address
Optional
T-Shirt Size (Only Applies If You Register By January 1, 2021)
Optional
Related Health concerns:
Special Communication needs?
Please select one option.
Yes
No
Select Option
Yes
No
If yes, please explain.
Optional
Sensory Issues/Concerns (strobe lights, camera flashes, loud noises, etc.):
Optional
Allergies - Please list any that apply: foods, animals, latex, makeup, plants, pollen, etc.):
Optional
Do You Have Access To The Internet?
Please select one option.
Yes
No
Select Option
Yes
No
Do You Have Access To A Computer Or Tablet?
Please select one option.
Yes
No
Select Option
Yes
No
If No, Would You Be Able To Borrow A Computer Or Tablet From A Friend Or Family Member?
Please select one option.
Yes
No
Select Option
Yes
No
Would You Like The NTS Parade To Come To Your Location Prior To The Event? (You Must Be Located Within 15 Miles Of The Church Location)
Please select one option.
Yes
No
Select Option
Yes
No
Fun Fact about you:
Is There Anything We Can Be Praying About For You?
Parent/Caretaker Information
Parent/Caretaker Name(s):
Parent/Caretaker Phone:
Care Provider Agency - If Applicable
Care Provider Agency:
Optional
Care Provider Agency phone:
Optional
Agency Chaperone During Virtual Event (If Applicable):
Optional
Additional Notes/Concerns:
Optional
*** Please click on the links below to download the Participant Media Rights Release, Parent/Caretaker Media Rights, and Liability Release forms must be completed, and require a signature. Please download and print the form to return to Hope Church. If you are unable to print the form, please contact us so we can assist.***
Night To Shine Participant Media Release
Night To Shine Parent:Caretaker Media Release
Night To Shine Liability Release
Please fax, scan, mail, or bring forms to:
Hope Church
Atten: Kelsey Bolton
1118 Franklin Turnpike, Danville VA 24540
kelsey@ourhopechurch.com
Fax: (434) 836-5092
Submit
Description
Please complete and submit to register as our guest for the Night to Shine event.
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