Night to Shine- 2023 Registration Form

Night To Shine Guest Registration

Step 1 of 4 - Guest Information

Parent/Caretaker Information
Parent/Caretaker Name(s):*
First Last
Parent/Caretaker Phone:
If enjoying Respite Room, please limit to two Parents or Caretakers.
First Last
* 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.
First Last
* 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.

Care Provider Agency Information - If Applicable
Care Provider Agency

(If attending as a part of a group, please include agency or company name)
Care Provider Agency Phone:
Agency Chaperone (if applicable):
Agency Chaperone Cell Phone:
(Note: Chaperone is not required to stay with guest(s) unless required by Care Provider Agency. If Chaperone remains with guest, a Background Check will be required.)
Additional Notes or Concerns:

Night to Shine Parent/Caretaker Media Rights Release
Media & 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.
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 of Parent/Caretaker:*
Address*
Street Address City State ZIP Code
Phone*
Email*
Participant Information (Name of Guest Attending Night to Shine)
Date*
MM slash DD slash YYYY

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Night to Shine- 2023 Registration Form

Night To Shine Guest Registration

Step 1 of 4 - Guest Information

Parent/Caretaker Information

Care Provider Agency Information - If Applicable

Night to Shine Parent/Caretaker Media Rights Release