Dreamnight Prom Registration

Parent/Guardian's Name

First Last

Address

Street Address City State ZIP Code

Phone

I give permission for my teen to be photographed at prom:

Can you help find or secure donated door prizes?

Would you be able to help in any other capacity? If yes, please contact us: (520) 777-4911 or email: info@candlelightersaz.org

Attendee Information

Prom Attendee

First Last

Age

Phone

Email

Select the service(s) you would like to receive

Special diet, in treatment, other considerations?

Guest's Name

First Last