Night to Shine Honored Guest Registration - McAlester Campus

Honored Guest Full Name:

Name as you would like it to appear on name tag:

Date of birth:

Age (MUST be 14 by date of event):

Gender:

Male Female

T-shirt size:

Address:

Email:

This address will receive a confirmation email

Best way to receive event updates:

Call Text Email Social Media

Fun fact about you (will be read on the red carpet):

Emergency Contact during event (will be listed on guest's name tag):

Emergency Contact phone number:

Does the Honored Guest have a caregiver or friend that is volunteering to be their Buddy?(Buddies must be 16y/o or older) YES NO

If you answered yes, please write their first and last name.(All Buddy's must fill out a volunteer form.)

How will Honored Guest be arriving/leaving event?

I will arrive/leave on my own Parent/caregiver will drop off/pick up Honored Guest Honored Guest will arrive with a group

If arriving with a group, group name:

We would love to make your Night to Shine experience the best it can possibly be. If you are comfortable sharing, please answer any of the following that apply to help us offer the best support we can. If it doesn't apply, put none.

Wheelchair: Yes, able to transfer Yes, not able to transfer No

Mobility Needs:

Health Concerns:

Communication Needs:

Sensory Issues/Concerns (ex: strobe lights, camera flashes, loud noises, etc.) (Please be specific):

Allergies (Please list all that apply: FOODS, animals, latex, makeup, plants, etc.) (Please be specific):

Food Needs (food cut-up, gluten free, dairy free, nut free, sugar free, etc.):

Additional Notes/Concerns You Would Like Us to Be Aware Of:

Caregiver Information

Caregiver Name(s):

Caregiver Phone:

Caregiver will be:

Dropping off Guest and leaving Dropping off guest and staying in the Respite Room Volunteering during the event (Please fill out volunteer form for yourself)

The Respite Room is a private area where caretakers of guests can spend the evening enjoying food, entertainment, and rest while remaining onsite during the event. Please list the names of the caretakers who plan to enjoy the Respite Room:

Care Provider Agency Information – If Applicable

Care Provider Agency (If attending as a part of a group, please include agency or company name):

Agency Chaperone Cell Phone (Chaperone is not required to stay with guest(s) unless required by Care Provider Agency. If Chaperone is staying with guest(s), please fill out a volunteer form.):

Additional Notes or Concerns:

Night to Shine Participant (Guests & Volunteers) Media Rights Release.

For the good and valuable consideration of participating in an event hosted by Community Culture Church McAlester, and sponsored in part by or associated with the Tim Tebow Foundation, I hereby give my full consent to Tim Tebow Foundation, Inc., (“TTF”) a Georgia nonprofit corporation headquartered in Florida and Community Culture Church McAlester (“CCC McAlester”), an Oklahoma nonprofit corporation, to record, by writing, by video, photographic, or audio recording device, or by any other analog or digital means, my actions, physical likeness, biographical information, and/or voice. Additionally, I hereby grant to TTF and CCC McAlester without royalty or other compensation now or in the future, all rights of every kind and character whatsoever, in perpetuity, in and to any and all such recordings, along with any additional recordings I might provide to TTF and CCC McAlester, and to any benefits inuring to TTF and CCC McAlester as a result of its use of any of the foregoing recordings. Among other things, TTF and CCC McAlester may, but are not required to, copy or reproduce the recording, edit or modify it, incorporate it into another work, display or broadcast it or any of the foregoing privately or publicly, and use or license it or any of the foregoing for use by others, all for the sole benefit and at the sole discretion of TTF and CCC McAlester, for the advancement of TTF and CCC McAlester’s exempt charitable purposes. All permissions granted herein extend to any successor or assign of TTF and CCC McAlester and bind me and my heirs, successors, and assigns. I, hereby release and discharge and agree to hold harmless TTF and CCC McAlester, its directors, officers, employees, volunteers, and independent contractors, from any and all claims or damages, including but not limited to defamation or violation of rights of privacy or publicity, arising from or associated with the recordings or use of recordings. This release shall be construed, interpreted and governed in accordance with the laws of the State of Florida, and should any provision of this release be determined invalid, such invalidity does not affect any of the remaining provisions. I am of full age and have the right to contract in my own name.

Do you give Community Culture Church-McAlester permission to share photos and/or videos of the Honored Guest taken during the event?

Yes No

Description

Friday, February 12th, 2027

Night to Shine 2027 is a world wide prom event for people with special needs sponsored by the Tim Tebow Foundation and hosted by Community Culture Church and the community of McAlester. It is held annually on the Friday before Valentine’s Day, and this event is catered to guests who are 14 years and older.

Honored guests of Night to Shine will be treated like royalty! This unforgettable evening includes hair and makeup touch-ups, a limousine ride, a memorable red-carpet experience, a catered meal, and special party favors. Guests will enjoy dancing with friends on the dance floor, relaxing in a sensory-friendly space to decompress, and capturing special memories at multiple photo opportunities throughout the evening. The celebration reaches its royal finale with the crowning of our very own Kings and Queens, making Night to Shine a truly magical and memorable night for everyone!

This complimentary event celebrates people with special needs which fosters a sense of JOY and BELONGING within the community.

Parents & Caregivers, this night is for you, too! Enjoy your own dedicated respite space with a delicious meal, games, prizes, and a live stream of the Night to Shine celebration.

Night to Shine Honored Guest Registration - McAlester Campus

Description

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