Request edit access
Night to Shine 2019 Buddy Registration
Event to be held at:
St. Paul Lutheran Church and School
Boca Raton, FL
Friday February 8, 2019
6:00 PM to 9:00 PM
Email address *
Last name *
Your answer
First name *
Your answer
Phone number *
Your answer
Age (on February 8, 2019) must be 16 or older *
Gender *
Comments
Your answer
Media and Liability Rights Release
By signing below, and for the good and valuable consideration of participating in an event hosted by ST. PAUL, 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 St. Paul Evangelical Lutheran Church of Boca Raton Florida Inc (“ST. PAUL”), a STATE nonprofit corporation, to record, by writing, by video,
photographic, or audio recording device, or by any other analog or digital means, the actions, physical likeness, biographical information, and/or voice of me and/or any person of whom I am the parent or legal guardian, including minor children (collectively referred to as the “Participants”). Additionally, I hereby grant to TTF and ST. PAUL, 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 ST. PAUL, and to any benefits inuring to TTF and ST. PAUL as a result of its use of any of the foregoing recordings. Among other things, TTF and ST. PAUL 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 ST. PAUL, for the advancement of TTF and ST. PAUL’s exempt charitable purposes. All permissions granted herein extend to any successor or assign of TTF and ST. PAUL and bind the Participants and their heirs, successors, and assigns. I, on behalf of all Participants, hereby release and discharge and agree to hold harmless TTF and ST. PAUL, 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 recording 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 and for each Participant.
Agreed to and Accepted: Please type full name of participant (if over age 18) or type full name of parent or caregiver (if under age 18): *
Your answer
If you have an objection to the release above, please contact us on nighttoshineboca.com
A copy of your responses will be emailed to the address you provided.
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This form was created inside of St. Paul Lutheran Church. Report Abuse - Terms of Service