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 Maximum 20 characters Please fill out this field. Please enter a phone number.
Email REQUIRED Please fill out this field. Please enter an email address.
Please give the name and address of a person to contact in case of an emergency.
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 Maximum 20 characters Please fill out this field. Please enter a phone number.
Please indicate what area(s) you are interested in volunteering with: REQUIRED
Please select all areas you are interested in helping with.
Buddy (Must be 18) Happy to do anything Make-up/Shoe Shine Parent Dinner Sensory Room Parking Attendants Food/Drink Distribution Registration Flowers/Crowns/Tiaras Please fill out this field.
If you selected "Buddy", where are we most likely to find you during the event? (This helps us pair you with an Honored Guest who shares similar interests!) On the dance floor enjoying the music Grabbing snacks and socializing Singing or cheering along at karaoke Relaxing upstairs and taking in the fun Playing bingo with my friends I’m happy to be anywhere!
Please indicate any special needs skills/training you have. Click all that apply. Fluent in American Sign Language (ASL) Special Education Teacher Special Education Paraprofessional Speech Pathologist Healthcare professional (please list field)
List area of healthcare skills (if applicable) Please enter valid data.
I have volunteered at Night to Shine Stillwater in the past REQUIRED Yes No Please fill out this field.
Is there a specific Honored Guest you hope to be paired with? If so, please share their name here.
Additional Notes or Concerns

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