Night To Shine - Guest Registration 2019

Please use this form to register Guests and Parent/Caregivers for the Night To Shine event at New Life Christian Church in Alexandria, MN.

Guest Information
Guest First Name
Guest Last Name
Name as you would like it to appear on the nametag
Guest Address
Guest City
Guest State
Guest Postal Code
Guest Email Address
Guest Phone
Guest Date of Birth
Guest Gender
Guest Interests

Emergency Contact during event
Emergency Contact Phone
Health Concerns (none, asthma, diabetes, seizures, etc)

Special Communication Needs (none, non verbal, limited speech, etc.)

Sensory Issues/Concerns (none, strobe lights, camera flashes, loud noises, etc.)

Allergies (none, food, latex, makeup, plant or pollen allergies, etc.)

Food Needs (none, food cut-up or pureed, gluten free, etc.)

Guest Media & Liability Rights Release
Who is the authorized person to sign the Guest Media & Liability Rights Release form on behalf of the Guest?
By signing below, and for the good and valuable consideration of participating in an event hosted by New Life Christian 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 New Life Christian Church (“CHURCH”), a Minnesota 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 the 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.
By signing below, and in consideration of being permitted to participate in Night To Shine hosted by New Life Christian Church (Event Provider), the Participant releases and forever discharges the Event Provider, its owners, directors, officers, employees, agents, assigns, legal representatives and successors from all manner of action, causes of action, debts, accounts, bonds, contracts, claims and demands for or by reason of any injury to person or property, including injury resulting in the death of the Participant, which has been or may be sustained as a consequence of the Participant's participation in the activity described below, and not withstanding that such damage, loss or injury may have been caused solely or partly by the negligence of the Event Provider.
Guest Authorization - By selecting "Yes" and entering the date, I am stating that I have read and agree to the above statements.
Name of Person providing authorization (Guest or Parent/Caregiver/Guardian)
Date of Guest Authorization
Parent/Caregiver Information
Parent/Caregiver Name(s)
Parent/Caregiver Phone
Parent/Caregiver will be
If enjoying onsite *Respite Room, how many? (maximum 2)
The Respite Room is a private room where parents/caregivers of guests can enjoy light refreshments and rest while remaining onsite at New Life Christian Church during the event.
*All family members, friends, and caregivers that will remain onsite during the event will be required to sign a Parent/Caregiver Media Rights Release form at the event registration. Anyone who will not provide consent will not be allowed to remain at the event.
Care Provider Agency Information (if applicable)
Care Provider Agency Name
Care Provider Agency Phone
Agency Chaperone (if applicable)
Additional Notes or Concerns

Are Required Fields