Night to Shine Guest Information
Please complete this form to help us make your child's experience fun and meaningful.
First Name *
Last Name *
Age/Date of Birth
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Street address
Zip code
Fun fact about you
Emergency contact name *
Emergency contact phone *
Health concerns?
Wheelchair or Accessibility Device?
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Special communications needs?
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If yes, please share more information.
Sensory Issues/Concerns (strobe lights, camera flashes, loud noises, etc.)
Allergies (please list any that apply: foods, animals, latex, makeup, plants, etc.) *
Food Needs (food cut-up or pureed, gluten free, dairy free, etc.)
Clear selection
If yes, please provide more information.
You must choose Option 1 or Option 2. *Space for Option 2 is extremely limited & will be determined on a first-come, first-served basis.
This year, we will have two event options. One is a drive-thru event & the other is a home visit. *Due to Covid restrictions, there will be no physical contact between a member of SMCC and your family.
*Choose which option you prefer. Both options include a meal for your household and a special gift bag for the participant. *
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