North Creek Presbyterian Church

Building Relationships

North Creek is a family-focused, Presbyterian and Reformed church. We are committed to the Lordship of Jesus Christ and to the Bible as the Word of God.

Guest Information

Guest Name *
Guest Name
DOB *
DOB
Male or Female *
Address *
Address
Emergency Contact Name *
Emergency Contact Name
Emergency Contact Phone (will be listed on guest’s nametag) *
Emergency Contact Phone (will be listed on guest’s nametag)
Wheelchair/Accessibility Device Dependent
Special Communication Needs *
(Please list any that apply: foods, animals, latex, makeup, plants or pollen, etc.)
Food Needs *
(food cut-­‐‑up or pureed, gluten free, dairy free, etc.)
Will 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 event? *
Will guest be attending as a part of a group that will provide transportation? *
Parent/Caretaker Name *
Parent/Caretaker Name
Parent/Caretaker Phone *
Parent/Caretaker Phone
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.
(If attending as a part of a group, please include agency or company name)
Care Provider Agency Phone *
Care Provider Agency Phone