Night To Shine 2026 Registration

Honored Guest

First and Last Name

Name as you would like it to appear on nametag

D.O.B

Gender

Male Female

Address

This address will receive a confirmation email

Phone

Fun Fact About You

Emergency Contact during event (will be listed on guest's nametag)

Emergency Contact Phone (will be listed on guest's nametag)

Will Need Medication Administered During Event (*Please note that the church, their staff, and volunteers are not responsible for administrating medication to guests during Night to Shine event. If Medication is required during the event, a parent or caregiver MUST be available to administer the medication

Yes No

I hereby grant the St. Paul Lutheran Church Harlingen Texas church permission to copyright and use photographs/videos taken at Night to Shine of the person designated above in any manner or form for any purpose lawful at any time. I waive any right that I may have to inspect or approve the finished product or written copy, that may be used in conjunction therewith, or the use to which it may be applied. I give permission for my child (named above) to attend the Vacation Bible School at St. Paul Lutheran Church. I understand that the information I give for this registration will only be used by St. Paul Lutheran Church. (Accept by clicking below)

Accept Permission Deny Permission

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 optional items that

apply in order to help us offer the best support we can.

Health Concerns

Mobility Needs

Communication Needs

Sensory Issues/Concerns (strobe lights, camera flashes, loud noises, etc.)

Allergies (Please list all that apply: foods, animals, latex, makeup, plants or pollen etc.)

Food Needs (food cut-up or pureed, gluten free, dairy free, nut free, etc.)

Additional Notes/Concerns You Would Like Us to be Aware of

Caretaker Information

Caretaker's Name

Caretaker's Phone

Caretaker's Relationship to guest

Care Provider Agency Information - If Applicable

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

Care Provider Agency Phone

Agency Chaperone (If Applicable)

Agency Chaperone Cell Phone

Description

Friday, February 13th 5:30-8pm

Please carefully fill out this form and click submit.
All honored guests must be 14 year and older!

Night To Shine 2026 Registration

Description

Please Fix the Following