Facebook YouTube Instagram

Night to Shine Guest Registration 2024

- The maximum number of form submissions has been reached. This form is currently not available.
  
  Guest Information
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Date of Birth (Must be 14 by February 9, 2024) REQUIRED Please fill out this field. Please enter a date.
  
  Age Please enter valid data.
  
  Gender REQUIRED Please fill out this field.
  
  Fun Fact about you: REQUIRED Please fill out this field. Please enter valid data.
  
  Health Concerns: Please enter valid data.
  
  Special Communication Needs: REQUIRED Please fill out this field.
  
  Sensory Issues/Concerns (strobe lights, camera flashes, loud noises, etc.): REQUIRED Please fill out this field.
  
  If yes, please explain: Please enter valid data.
  
  Allergies (Please list any that apply: foods, animals, latex, makeup, plants or pollen, etc.): REQUIRED Please fill out this field.
  
  If yes, please list allergies: Please enter valid data.
  
  Is there anything we can be praying about for you?
  
  Parent/Caretaker Information
  
  Parent/Caretaker Name: Please enter valid data.
  
  Email REQUIRED Please fill out this field. Please enter an email address.
  
  Parent/Caregiver Phone Number Maximum 20 characters Please enter a phone number.
  
  Care Provider Agency Information - If Applicable
  
  Care Provider Agency: (If attending as a part of a group, please include agency or company name) Please enter valid data.
  
  Care Provider Agency Contact Phone Number Maximum 20 characters Please enter a phone number.
  
  Name of Agency Chaperone (if applicable) Please enter valid data.
  
  Additional Notes or Concerns:
  
  Participant Media Release (Parent/Caretaker sign if participant under 18)
  
  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.
  AGREED TO AND ACCEPTED Please select this field.
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Date REQUIRED Please fill out this field. Please enter a date.
  
  Signature of Participant (if over 18) Please enter valid data.
  
  Signature of Parent/Caretaker (if participant is under age 18) Please enter valid data.
  
  Address REQUIRED Please fill out this field. Please enter valid data.
  
  City/State/Zip Please enter valid data.
  
  Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Email REQUIRED Please fill out this field. Please enter valid data.
  
  Parent/Caretaker Media 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.
  AGREED TO AND ACCEPTED Please select this field.
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Date REQUIRED Please fill out this field. Please enter a date.
  
  Signature of Parent/Caretaker Please enter valid data.
  
  Address REQUIRED Please fill out this field. Please enter valid data.
  
  City/State/Zip REQUIRED Please fill out this field. Please enter valid data.
  
  Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Email REQUIRED Please fill out this field. Please enter valid data.
  
  Name of Participant: Please enter valid data.
  
  Submit
  
  This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.