Guest Registration Form
Event Date: February 7th, 2025
Event Time: 5-9
 Event Address: 11698 South Farm to Market Rd 730
Azle Tx 76020
Contact us at: azlenighttoshine@gmail.com
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Email *
Night to Shine Parent/Caretaker Media Rights Release By signing below, and for the good and valuable consideration of participating in an event hosted by 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 Edge CHURCH (“The Edge 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 Edge 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 Edge CHURCH, and to any benefits inuring to TTF and The Edge CHURCH as a result of its use of any of the foregoing recordings. Among other things, TTF and The Edge 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 Edge CHURCH, for the advancement of TTF and The Edge CHURCH’s exempt charitable purposes. All permissions granted herein extend to any successor or assign of TTF and The Edge CHURCH and bind me and my heirs, successors, and assigns. I, hereby release and discharge and agree to hold harmless TTF and The Edge 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. *
Required
Signature of Parent/Caretaker: *
Date: *
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Parent/Guardian/Caregiver Name: *
Phone *
Participant Name: *
Date of birth: *
Signature of Participant *
Date of Signature *
Gender *
Address of participant /City/State/Zip: *
Email: *
Years Old (Guests must be 14 or older to attend as a guest). *
Name as you would like it to appear on nametag *
Phone number *
Dietary needs *
Additional Notes/Concerns you might like us to be aware of *
Transportation *
Required
Fun fact about you *
Medication: Guest 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. *
Required
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 that apply order to help us offer the best support we can.
Health concerns *
Mobility needs *
Communication needs *
Sensory issues/concerns (strobe lights, camera flashes, loud noises, etc.) *
Behavioral issues/concerns we should be aware of. *
Allergies (please list any that apply:foods, animals, latex, makeup, plants or pollen, etc. *
Emergency contact during the event (will be on the back of guests name tag) *
Emergency contact phone (will be on the back of guests name tag) *
Care Provider/Agency InformationCare Provider Agency Information - If Applicable (If attending as a part of a group) if not put N/A *
Care Provider Agency *
Caregiver Name *
Caregiver Phone Number *
Relationship to Guest *
Respite Room Attendants:The Respite Room is a private area where caretakers of guests can spend the evening enjoying dinner, entertainment, and rest while remaining onsite during the event. *
Required
If as a parent or caregiver you plan on enjoying the Respite Room*. please list up to two guests.
Name 1 for Respite Room *
Name 2 for Respite Room *
Care Provider Agency Phone *
Agency Chaperone (if applicable) *
Agency Chaperone Cell Phone *
(Note: Chaperone is not required to stay with guest(s) unless required by Care Provider Agency. If Chaperone remains with guest. a current Background Check will be required *
Additional Notes or Concerns *
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