Volunteer Registration Form

First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.

Date of Birth REQUIRED Please fill out this field. Please enter a date.

Gender REQUIRED Male Female Please fill out this field.

Address REQUIRED Please fill out this field. Please enter valid data.

City REQUIRED Please fill out this field. Please enter valid data.

State REQUIRED Please fill out this field.

Zip REQUIRED Please fill out this field. Please enter a zip code.

Phone Number REQUIRED Please fill out this field. Please enter a phone number.

Email REQUIRED Please fill out this field. Please enter an email address.

If under the age of 18, please give parental information:

First Name Please enter valid data.

Last Name Please enter valid data.

Emergency Contact Information During Event:

First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.

Phone Number REQUIRED Please fill out this field. Please enter a phone number.

Prior Special Needs Skills/Training (click all that apply) Fluent in American Sign Language (ASL) Special Education Teacher Special Education Paraprofessional Healthcare Professional (please list field)

Health Care Field: Please enter valid data.

I have volunteered at Night to Shine in the past. REQUIRED Yes No Please fill out this field.

Volunteer Options REQUIRED

Select the area where you would like to volunteer

Buddy (18 years and older, please) Parent Prom Willing to help in any area Please fill out this field.

Additional Notes or Concerns:

If you are under the age of 18 a permission slip signed by a parent is required to volunteer. Link is on next page.

Background checks are required for ALL volunteers over the age of 18. Permission slip is available on next page.

Night to Shine Stillwater

Friday, February 10, 2023

Volunteer Registration Form