Night to Shine Amarillo Guest Registration Form

Night to Shine Amarillo Late Guest Registration Form

This form is only for the Night to Shine event hosted in Amarillo, Texas.
There are a special set of rules for our Late Guest Registration. They can be viewed at https://www.nighttoshineamarillo.com/late-guest-registration
I have read the rules for Late Guest Registration and will abide by them.
Guest Information
Guest Name*

First NameLast Name
Preferred Name, for Name Tag:
Email Address*
Phone Number*
Please enter a valid phone number.
Mailing Address*

Street Address

Street Address Line 2

CityState

Zip Code
You entered a state other than Texas. This registration is only for the event held in Amarillo, Texas. Click the box below if you are traveling to Amarillo, Texas for the event and wish to continue signing up for the Night to Shine in Amarillo.*

I understand that this registration is only for Amarillo, Texas.
Age*
Gender*

MaleFemale
Fun Fact About the Honored Guest!

Buddy Information
Every guest is paired with a Buddy. If the guest has significant health concerns or needs, a parent or caretaker must stay with them and serve as their buddy. We quickly run out of buddies who have experience with people with special needs.

The guest does not have significant health concerns and can be paired with a buddy who does not have experience with people with special needs.A parent or caretaker will spend the entire evening with the guest and serve as their buddy.

Emergency Contact Information
Emergency Contact Name- This person MUST stay at the Civic Center during the Event, either in the Respite Room, or as the Buddy.*

First NameLast Name
Emergency Contact Phone Number*
Please enter a valid phone number.
THE EMERGENCY CONTACT MUST STAY AT THE CIVIC CENTER DURING NIGHT TO SHINE! How many parents or caretakers will go to the Respite Room? *
The Respite Room is a private area where parents/caretakers of guests can spend the evening enjoying food, entertainment and rest while remaining on site during the event.
Where is the Emergency Contact volunteering?*

Medical and Food Information
Please provide as much detail as possible.
The following information is used for the Buddy Cards that each buddy will get. This will allow the buddies to get to know the guest better.
Health Concerns- please be as descriptive as possible.
Special Communication Needs- please be as descriptive as possible.
Sensory Issues/Concerns. Please provide information on how we can help the guest if they begin to experience sensory issues or sensory overload.
Does the guest have any food allergies? It is not possible for us to accommodate allergies for our guests who register late. You will need to bring them their own meal if they cannot eat off the buffet.

NoYes, and we will bring their own meal.
Does food need to be pureed or cut up?*

NoPureedCut up
Anything else you would like us to know?

Consent Items
I understand that at least one parent or caretaker must stay at the civic center during Night to Shine and I will adhere to this policy.
I understand that volunteers will not be allowed to administer any medication at Night to Shine.
Liability Release and Agreement (required for attendance): In consideration of acceptance of my participation in “Night to Shine Amarillo” at The Amarillo Civic Center, hosted by The Loft Church on February 7, 2025, I hereby understand and acknowledge the following contractual representations and agreements: 1. Participation in this event/activity is entirely voluntary but may include physical and cardio effort. Before you engage in any event/activity of this type, you should consult with your doctor. By signing the form below, you fully realize the dangers of participation in an event/activity of this type and voluntarily assume all of the risks associated with such participation. 2. By signing the form below, you agree that you are solely responsible for your own health and safety during the above-referenced event/activity, and you fully release any and all claims against the event/activity organizers, your fellow participants/volunteers, The Loft Church, The Tim Tebow Foundation, The City of Amarillo, and any employees of these parties for any injuries, loss or harm arising from your participation in this event/activity. 3. In the event that any one or more of the provisions of this Agreement shall be held to be invalid, unenforceable or in conflict with the law according to the jurisdiction of the State of Texas, Potter County, the remaining portions will not be invalidated and shall remain in full force and effect. I acknowledge that I have read, understand and agree to the terms of this Release and Agreement. This Release and Agreement represents my complete understanding regarding these issues and no oral representation, statements or inducements have been made apart from what is contained in this document.*

I agree
Media Rights Release (required for attendance): By agreeing below, and for the good and valuable consideration of participating in an event hosted by The Loft 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 The Loft Church, a Texas 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 The Loft 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 The Loft Church, and to any benefits inuring to TTF and The Loft Church as a result of its use of any of the foregoing recordings. Among other things, TTF and The Loft 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 The Loft Church, for the advancement of TTF and The Loft Church's exempt charitable purposes. All permissions granted herein extend to any successor or assign of TTF and The Loft Church and bind me and my heirs, successors, and assigns. I, hereby release and discharge and agree to hold harmless TTF and The Loft 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.*

I agree
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First NameLast Name
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Night to Shine Amarillo Late Guest Registration Form

There are a special set of rules for our Late Guest Registration. They can be viewed at https://www.nighttoshineamarillo.com/late-guest-registration