Date of Birth:
Gender: FemaleMale

Address
Street:
City:
State:
Zip Code:

Phone:

Parent Name: (if under 18):
Parent Phone:

Emergency Contact:
Emergency Contact Phone:

TRAINING AND SKILLS INFORMATION
Former Special Needs Skills / Training (please check all that apply)
Fluent in American Sign Language (ASL)Special Education TeacherHealthcare ProfessionalOther

If you check other, please describe:

If you selected Healthcare Professional, please list your field or specialty:

Do you have any other specialized training? (Please list and describe any specialized training)

Preferred Service Team for the Night to Shine Event:

Secondary Service Team Option (Please select an alternate, you may need to be assigned to another team)

There are other volunteer opportunities before our event. Please consider joining an event preparation team at a volunteer training meeting.
Clothing / Flowers / Prom Shop
Encouragement Cards
Gift Bags
Gym Decorating
Respite Room Decorating