Night to Shine- Shine Thru 2021 Registration Form Night To Shine Guest Registration Step 1 of 3 - Guest Information 33% Name* First Last Age/DOB* Gender* Female Male Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Email* Phone*Fun fact about you:*Primary contact name during virtual event:* First Last Contact phone number:*Health concerns:*Special communication needs?* No Yes If yes, please explain:*Sensory issues/concerns (strobe lights, camera flashes, loud noises etc):*Allergies:*Please list any that apply: Foods, animals, latex, makeup, plants or pollen etc.Do you have access to the internet?* No Yes Do you have access to a computer or tablet?* No Yes If no, would you be able to borrow a computer or tablet from a friend or family member? No Yes What is your preferred social media platform?* Parent/Caretaker Name(s):* First Last Is there anything we can be praying about for you? Care Provider Agency Information - If ApplicableParent/Caretaker Phone:Care Provider Agency Phone:Agency Chaperone (if applicable): Additional Information Night to Shine Parent/Caretaker Media Rights ReleaseMedia & Liability Rights Releases Participant/Parent/Caretaker agrees to the Media & Liability Rights Release By registering, you agree to Night to Shine's Participant and Parent/Caretaker Media & Liability Rights Release Forms and Night to Shine's Participant Permission Form.Night to Shine Parent/Caretaker Media Rights Release By signing below, and for the good and valuable consideration of participating in an event hosted by CHURCH, and sponsored in part by or associated with the Tim Tebow Foundation, I hereby give my full consent to Tim Tebow Foundation, Inc., (“TTF”) a Georgia nonprofit corporation headquartered in Florida and CHURCH (“CHURCH”), a STATE nonprofit corporation, to record, by writing, by video, photographic, or audio recording device, or by any other analog or digital means, my actions, physical likeness, biographical information, and/or voice. Additionally, I hereby grant to TTF and CHURCH, without royalty or other compensation now or in the future, all rights of every kind and character whatsoever, in perpetuity, in and to any and all such recordings, along with any additional recordings I might provide to TTF and CHURCH, and to any benefits inuring to TTF and CHURCH as a result of its use of any of the foregoing recordings. Among other things, TTF and CHURCH may, but are not required to, copy or reproduce the recording, edit or modify it, incorporate it into another work, display or broadcast it or any of the foregoing privately or publicly, and use or license it or any of the foregoing for use by others, all for the sole benefit and at the sole discretion of TTF and CHURCH, for the advancement of TTF and CHURCH’s exempt charitable purposes. All permissions granted herein extend to any successor or assign of TTF and CHURCH and bind me and my heirs, successors, and assigns. I, hereby release and discharge and agree to hold harmless TTF and CHURCH, its directors, officers, employees, volunteers, and independent contractors, from any and all claims or damages, including but not limited to defamation or violation of rights of privacy or publicity, arising from or associated with the recordings or use of recordings. This release shall be construed, interpreted and governed in accordance with the laws of the State of Florida, and should any provision of this release be determined invalid, such invalidity does not affect any of the remaining provisions. I am of full age and have the right to contract in my own name.Name* First Last Signature* Δ
