Night to Shine - Waycross

Guest Registration

Address

Street Address *

City *

State *

Country *

Postal code *

Guest Name Tag *

Guest Fun Fact

Additional Detail About The Guest

Does the Guest Have Any Allergies *

Yes

No

Will Guest Require Medication Administration During Event? *

Yes

No

Please note that 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.

We strive to make your Night to Shine experience the best it can possible be. If you are comfortable sharing, please answer any of the following optional items that apply in order to help us offer the best support we can. If not relevant, please omit.

Health Concerns

Communication Needs

Non-verbal

Uses devices

Difficult to understand

Other (List below)

Expand on 'Other' Answers

Would guest like a "Quiet Entrance"? *

Yes

No

Quiet Entrance = No cheering, No Camera Flash, etc

Parent/Caretaker Information

(Any updates or reminders will be sent to this contact info.)

Caretaker's Relationship to Guest *

Caretaker Phone *

Caretaker Email *

Respite Room Info *

Dropping Guest Off

Enjoying Respite Room

The Respite Room is a private area where TWO parents/caretakers can spend the evening enjoying food, entertainment, and rest while remaining onsite during the event. Please remember this is a special time in a relaxing environment and we ask that no one under the age of 18 is in the respite area. || Limit (2) attendees - please list them below.

Care Provider Agency Information - If Applicable

Will Guest be attending as part of a group or agency? *

Yes

No

Liability Release

I agree to hold One Church and its agents and employees harmless from any and all liability, actions, causes of actions, claims, expenses, and damages on account of injury to myself or any family member present, even injury resulting in death, which may now exist, or which may arise in the future in connection with the activity or participation in any other associated activities.

Liability Release Signature *

Clear

Night to Shine Participants 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.

Media Rights Release Signature

Clear

SMS Notifications Agreement *

By checking this box, I consent to receive transactional messages related to my account, orders, or services I have requested. These messages may include appointment reminders, order confirmations, and account notifications among others. Message frequency may vary. Message & Data rates may apply. Reply HELP for help or STOP to opt-out.

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Night to Shine Waycross