2018 Night to Shine Special Needs Guest Registration
*While you are attending any aspect of the Night to Shine event, you may randomly be selected as a group or individually to have your picture taken. Objection to your picture be used for ministry and promotional purposes, should be expressed to Denise Pritchett at dpritchett@theplaceofhope.com prior to the event.
First Name *
Your answer
Last Name *
Your answer
Mailing Address *
Your answer
City *
Your answer
State *
Your answer
Zip *
Your answer
Phone Number *
Your answer
Email Address *
Your answer
Sex *
Age *
Your answer
Did you attend Night to Shine 2017? *
Please tell us of any special accommodations you may need
Your answer
Number of People Attending With You *
Attendee Caregiver/Guardian/Contact Name *
Your answer
Caregiver/Guardian Mailing Address *
Your answer
Caregiver/Guardian City *
Your answer
Caregiver/Guardian State *
Your answer
Caregiver/Guardian Zip *
Your answer
Comments
Your answer
By signing below, and/or by or in consideration for participating in an event hosted by, sponsored by, or associated with the Tim Tebow Foundation and Pleasant Grove Baptist Church, I hereby give my full consent to Tim Tebow Foundation, Inc., (“TTF”) a nonprofit corporation headquartered in Florida and Pleasant Grove Baptist Church (“Pleasant Grove Baptist Church”), a Georgia 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 Pleasant Grove Baptist 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 Pleasant Grove Baptist Church, and to any benefits inuring to TTF and Pleasant Grove Baptist Church as a result of its use of any of the foregoing recordings. Among other things, TTF and Pleasant Grove Baptist Church may, but is 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 Pleasant Grove Baptist Church, for the advancement of TTF and Pleasant Grove Baptist Church exempt charitable purposes. All permissions granted herein extend to any successor or assign of TTF and Pleasant Grove Baptist Church and bind the Participants and their heirs, successors, and assigns. I, hereby release and discharge and agree to hold harmless TTF and Pleasant Grove Baptist 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 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. *
Required
Please type your name in the box below indicating that you agree with the above statement *
Your answer
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.