nts guest | David Baptist Church

Guest Registration Page

Guest Registration - Night to Shine

First name

Last name

Name as you would like it to appear on nametag:

Birthday

Month

Day

Year

Gender

Male

Female

Address

City

State

Zip Code

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:

Yes

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.

Will Guest be dropped off and picked up by parent/caretaker?

Yes

Caretaker Phone:

Caretaker Will Be:

Dropping Guest Off

Enjoying Respite Room

Caretaker Relationship to Guest:

If enjoying Respite Room*, please list Caretakers:

Caretaker Name 1

Caretaker Name 2

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:

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

Care Provider Agency Phone:

Agency Chaperone (If Applicable):

Agency Chaperone Cell Phone:

(Note: Chaperone is not required to stay with guest(s) unless required by Care Provider Agency. If Chaperone remains with guest, a current Background Check will be required.)

Additional Notes or Concerns:

Remit form to:

David Baptist Church

2300 David Baptist Church Rd

Kings Mountain, NC 28086

or Email to davidbaptist2016@gmail.com

Fax: 704-739-1483

File upload

DAVID BAPTIST CHURCH WELCOMES YOU!

Guest Registration Page

Guest Registration - Night to Shine