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Night to Shine Guest Registration

We are so excited to having you joining us for Night to Shine sponsored by the Tim Tebow Foundation, hosted by Calvary Chapel Eastside!  Before you fill out the registration form below, please take a moment to fill out the Parent/Caretaker Media & Liability Rights Release for this event.

Name *
Name
Address *
Address
Phone *
Phone
Emergency Contact during Event *
Emergency Contact during Event
Emergency Contact Phone *
Emergency Contact Phone
(strobe lights, camera flashes, loud noises, etc.) Please write N/A if not applicable.
Please list all that apply: food, animals, latex, makeup, plants, pollen, etc. Please write N/A if not applicable.
(food cut-up or pureed, gluten free, etc)
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.
Parent/Caretaker Name *
Parent/Caretaker Name
Parent/Caretaker Phone *
Parent/Caretaker Phone
Additional Parent/Caretaker Name
Additional Parent/Caretaker Name
Parent/Caretaker Phone
Parent/Caretaker Phone
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 Phone - If Applicable
Care Provider Agency Phone - If Applicable
Agecny Chaperone - If Applicable
Agecny Chaperone - If Applicable
Note: Chaperone is not required to stay with guest(s) unless required by Care Provider Agency