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* 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.

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Parent/Caretaker Information

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* 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 Provider Agency)