This registration form is for guests of SWFL Naples Night to Shine only. To register for the Cape Coral or Sanibel Island Night to Shine, please visit their website. 

Guest Information

Wheelchair/Accessibility Device Dependent:
Special Communication Needs

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

Special Food Needs (food cut up or pureed, gluten free, etc.)
Will guest need medication administered during event?

* 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 a parent/caretaker?
Will guest be taking public transportation to and from the event?
Will guest be attending as part of a group that will provide transportation?

Parent/Caretaker Information

Parent/Caretaker will be:

* The Respite Room is a private area where parents/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 part of a group, please include company or agency name.)

(Note: Chaperone is not required to stay with guest(s) unless required by Care Provider Agency)