register-attend | Night To Shine Texoma

Register to Attend

FIrst Name of Attendee*

Last name of Attendee*

Email*

Phone Number*

Current Age*

Gender*

Address*

Address 2 (Apt/Suite # etc.)

City*

State*

Zip Code*

Emergency Contact Name (available during Night to Shine)*

Emergency Contact Phone Number (available during Night to Shine)*

Health Concerns:

Communication Needs:

Sensory Issues/Concerns:

Food Needs:

Wheel Chair?

Yes

No

Need Medication Administered During Event? (*Please note that we are unable to administer medication to guests during the event. If medication is required during the event, a parent or caretaker MUST be available to administer it.

Yes

No

What is something you love or are passionate about?

Fun Fact About You?*

Are you ok with us taking your pictures/videos of you during the event?*

Yes

No

Do you agree to the media release and liability release form? (see links at the top of page)*

I Agree (required)

No

How many parents/guardians/caretakers will join us in the respite room? *The Respite Room is a private area where caretakers of guests can spend a relaxing evening enjoying a nice dinner, entertainment, and rest while remaining onsite during the event.*

0

1

2

What are the names of the people who will join us in the respite room?*

Any additional notes you would like us to be aware of?

I understand that this registration does not guarantee attendance at Night to Shine. By registering, I will be placed on a waitlist, and if a spot becomes available, I will be contacted in the order of sign-ups.*

Yes, I understand this Registration will put me on the Waitlist

At this time, we have reached capacity for Night to Shine. However, if you’d like to be placed on the waitlist, please click the button below to register. If any spots become available, we will reach out to those on the waitlist in the order they signed up.

Location:

Fusion Bible Church
1097 Gerlach Dr.
Durant, OK 74701
580.920.9955

If you prefer to fill out paper registration and release forms, you may pick up a copy of each at the Fusion Bible Church office at the address above.
If you have any questions, feel free to call the church office, email at nighttoshine@fusiondurant.com,
or fill out our contact form on this website.

Link to the Liability Release Form
(CLICK HERE)
Link to the Guest Media Release Form
(CLICK HERE)
Link to the Parent & Caretaker
Media Release Form
(CLICK HERE)

Please fill out the information below to be put on the waitlist: