Night to Shine 2024 Volunteer Registration

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I confirm that I plan to Volunteer at Night to Shine 2024 hosted at St. Luke Catholic Church, Middleburg, FL REQUIRED Yes No Please fill out 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.
Name you would like on your name tag REQUIRED Please fill out this field. Please enter valid data.
Age (If under 18, a parent/guardian must sign attached forms) REQUIRED Maximum 114 characters Please fill out this field. Please enter an integer (number) from 0 to 114.
Date of Birth (MM/DD/YYYY format) REQUIRED Please fill out this field. Please enter a date.
Gender REQUIRED Please fill out this field.
Email REQUIRED Please fill out this field. Please enter an email address.
Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
T-Shirt Size (Adult Sizes Only)
Are you a registered parishioner of St. Luke Catholic Church? REQUIRED Please fill out this field.
Emergency Contact during event Please enter valid data.
Emergency Contact Phone Number Maximum 20 characters Please enter a phone number.
Background checks are required for ALL volunteers over the age of 18 no later than 1/27/2024.
I have a Diocese of St. Augustine background check on file within the last 4 years: REQUIRED Please fill out this field.
"Protecting God's Children" clearance is required for ALL volunteers over the age of 18 no later than 1/27/2024.
I am Protecting God's Children Certified: REQUIRED Please fill out this field.
If no, or not sure, please contact the office at office@stlukesparish.org for additional information to complete the Diocese of St. Augustine background check.
*If the volunteer is under the age of 18, the attached "Permission Slip for Minors" must be completed and signed by a parent/guardian.
Parent/Guardian Name (if under 18) Please enter valid data.
Parent/Guardian Phone (if under 18) Please enter valid data.
Parent Email Please enter an email address.
Former Special Needs Skills/Training (please check all that apply): Fluent in American Sign Language (ASL) Know some Sign Language Special Education Teacher Healthcare Professional Other
If Healthcare Professional or Other selected, please list details: Please enter valid data.
I have volunteered at Night to Shine before: REQUIRED Please fill out this field.
If Yes, what role? Please enter valid data.
Media Rights Release:
Media Rights Release
Diocese of St. Augustine
Catholic Center
11625 Old St. Augustine Rd.
Jacksonville, FL 32258

Without compensation, I hereby grant permission to the Catholic Diocese of St. Augustine to use and reproduce photographs and/or video taken of my child/myself. These photographs may be used for news and editorial purposes in publications and other electronic reproductions (websites and video) and/or brochures. In addition, I grant my permission to alter the same photos without restriction and to copyright the same. I hereby release the photographer, the journalists and the publications or media outlets they represent, as well as, the parish/church and/or school involved, the Bishop of the Diocese of St. Augustine, a corporation sole, the Catholic Dioceses of St. Augustine and all of their employees and agents, from all claims and liability relating to said photographs.

I Agree Please select this field.
Volunteer Name Please enter valid data.
Parent/Guardian Name if volunteer is under 18 Please enter valid data.
Date REQUIRED Please fill out this field. Please enter a date.
Volunteer Permission Slip for Minors (Under the age of 18) to be filled by Parent/Guardian
- I give my permission for my child to participate as a volunteer at the 2024 Night to Shine, sponsored by the Tim Tebow Foundation at St. Luke Catholic Church on Friday, February 9, 2024.
  
  I Agree Please select this field.
- By my signature I give my child permission to attend the event identified above and do hereby release, indemnify, and hold harmless Bishop Erik Pohlmeier, personally and as Bishop of the diocese of St. Augustine, a corporation sole; the Diocese of St. Augustine; St. Luke Catholic Church, their employees, agents, representatives, affiliates, and volunteers from any and all demands, claims, injury, medical and liability arising out of any participation while attending Night to Shine.
  
  It is further acknowledged that Night to Shine is being attended at our own risk, and St. Luke Catholic Church and The Diocese of St. Augustine is not responsible for medical coverage or reimbursement of any costs.
  
  I hereby waive any claim by the participants to a lawsuit against the Diocese of Saint Augustine or any such persons for any liability arising out of participation in this activity.
  I Agree Please select this field.
- Volunteer Name under 18 Please enter valid data.
- Parent/Guardian Name if volunteer is under 18 Please enter valid data.
- Date Please enter a date.

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