Night to Shine VIP Registration February 12th 2027

VIP(Guest) Information
Name

First NameLast Name
Name as you would like it to appear on nametag
DOB
Address
City
State
Zip Code
Email
example@example.com
Phone
Format: (000) 000-0000.
Fun Fact About You
Emergency Contact during event will be listed on guests nametag
Emergency Contact Phone will be listed on guests nametag
Format: (000) 000-0000.
Will Need Medication Administered During Event:
* Please note that the church, their staff, and 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.
Will guest be dropped and picked up by parent/caretaker?
Will guest be taking public transportation to and from event?
We would love to make your Night to Shine experience the best it can possibly be. If you are comfortable sharing, please answer any of the following optional items thatapply in order to help us offer the best support we can.
Health Concerns
Mobility Needs
Communication Needs
Sensory IssuesConcerns strobe lights camera flashes loud noises etc
Allergies: (Please list any that apply: foods, animals, latex, makeup, plants or pollen, etc
Food Needs food cutup or pureed gluten free dairy free nut free etc
Additional NotesConcerns You Would Like Us to Be Aware Of
Caretaker Names
Caretaker Phone
Format: (000) 000-0000.
Caretaker will be Dropping Guest Off:
Caretaker will be:
Caretaker relationship to guest
Name 1
Name 2
* The Respite Room is a private area where caretakers of guests can spend the evening enjoying food, entertainment, and rest while remaining onsite during the event.

Care Provider Agency Information - If Applicable

(If attending as a part of a group, please include agency or company name)
Care Provider Agency Phone
Format: (000) 000-0000.
Agency Chaperone if applicable
Agency Chaperone Cell Phone: Note: Chaperone is not required to stay with guests unless required by Care Provider Agency. If Chaperone remains with guest, a current Background Check will be required
Format: (000) 000-0000.
Additional Notes or Concerns:
Night to Shine Participant ( Media Rights Release)

By signing below, and for the good and valuable consideration of participating in an event hosted by Faith Temple of Christ, and sponsored in part by or associated with the Tim Tebow Foundation, I hereby give my full consent to TimTebow Foundation, Inc., (“TTF”) a Georgia nonprofit corporation headquartered in Florida and Faith Temple of Christ, 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/orvoice. Additionally, I hereby grant to TTF and Faith Temple of Christ, 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 Faith Temple of Christ, and to any benefits inuring to TTF and Faith Temple of Christ as a result of its use of any of the foregoing recordings. Among other things, TTF and Faith Temple of Christ 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 Faith Temple of Christ, for the advancement of TTF and Faith Temple of Christ’s exempt charitable purposes. All permissions granted herein extend to any successor or assign of TTF and Faith Temple of Christ and bind me and my heirs, successors, and assigns. I, hereby releaseand discharge and agree to hold harmless TTF and Faith Temple of Christ, 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. AGREE TO AND ACCEPTED:
Name of Participant

First NameLast Name
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Signature of Participant (if over age 18):
Signature of Parent/Caretaker/Legal Guardian (if participant is under age 18):
Caregiver/Guardian Name

First NameLast Name
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Telephone:
Email:
example@example.com
Should be Empty:

VIP(Guest) Information

Night to Shine Participant ( Media Rights Release)