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Night to Shine 2024 Guest Registration Form
Female guests wanting hair/makeup are asked to arrive at 4pm
Anyone not needing hair and make up will not need to arrive until 6pm
Event is located at Christ Temple Church 2400 Johnstown Road Huntington, WV 25701
February 9, 6-9pm
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* Indicates required question
Email
*
Your email
Guest's First Name
*
Your answer
Guest's Last Name
*
Your answer
Name as you would like it to appear on nametag:
*
Your answer
Date of Birth
*
Must be 14 or older by 3/1/24
MM
/
DD
/
YYYY
Age
*
Your answer
Gender
*
Male
Female
We have a qualified team of hairdressers, makeup artists, and nail techs. Would the guest like to receive any of these services by our team? Please choose as many of these services as you would like.
As always, all services are complimentary.
Hair
Makeup
Nails
None
Address
*
Your answer
City
*
Your answer
State
*
Your answer
Zip Code
*
Your answer
Fun Fact about you:
Your answer
Emergency Contact:
*
Your answer
Emergency Contact Phone:
*
Your answer
Health Concerns:
Your answer
Wheelchair:
*
Yes
No
Special Communication Needs:
*
Yes
No
Sensory Issues/ Concerns
strobe lights, camera flashes, loud noises, etc...
Your answer
Food Allergies:
Please list any that apply: Food, latex, makeup, etc.
Your answer
Food needs:
food cut up, pureed, gluten free, etc.
Your answer
Parent/ Caretaker Name
*
Your answer
Parent/ Caretaker Phone
*
Your answer
Parent/ Caretaker will be:
*
Dropping off Guest
Staying in Respite Room*
If enjoying Respite Room, how many?
The respite room is a private area where a parent or caretaker can spend the evening enjoying food, entertainment, and rest while remaining on-site during the event. It does have floor to ceiling views of the gym.
Your answer
Care Provider Agency:
If attending as part of a group, please include agency or company name
Your answer
Care Provider Agency Phone
Your answer
Agency Chaperone:
Note: chaperone is not required to stay with guest(s) unless required by care provider agency
Your answer
Would the guest like to do Karaoke or showcase their talent during the event? If so, please write the name of the song and artist of the song they would like to sing or the talent they would like to showcase.
*Be sure to give us specific details and we may need to follow up with you to get more information.
Your answer
Additional Notes or Concerns:
Your answer
A copy of your responses will be emailed to the address you provided.
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