Night to Shine South Atlanta Guest Registration

Guest Information
Gender: *
Wheelchair/Accessibility Device Dependant: *
Special Communication Needs: *
Food Needs (food cut-up or pureed, gluten free, etc.): *
Will need medication administered during event:
*Please note that the church, the school, 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 pickled up by a parent/caretaker?: *
Will guest be taking public transportation to and from the event?: *
Will guest be attending as apart of a group that will provide transportation?: *
Parent / Caretaker Information
Parent/Caretaker will be . . .
* 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 Information - If Applicable
(If attending as a part of a group, please include agency or company name)
* Note: Chaperone is not required to stay with guest(s) unless required by Care Pprovider Agency
Where did you find out about Night to Shine South Atlanta? *