Guest Information
Guest First Name
Guest Last Name
Guest Nickname
Guest Gender - Gender - Male Female
Guest DOB
Guest Age
Guest Address
Guest City
Guest State
Zipcode
Guest Disabilities
RED CARPET information: Please list this guest's favorite HOBBY and ACTIVITY and something this guest really enjoys (for example: Emily loves scrap booking, Special Olympics, and going to the movies). This will be announced as Guest enters event.
RED CARPET information
Parent/Guardian Information
Parent First Name
Parent Last Name
Parent Email
Parent Cell Phone
Parent/Guardian Will Be:
How many people will be joining us in the respite room?
Event Emergency Contact (If Other Than Parent/Guardian Above)
Event Emergency Contact First Name
Event Emergency Contact Last Name
Event Emergency Contact Cell Phone
If this Guest has a prearranged Buddy (date) who will be attending Night to Shine, you must provide name and phone number of Buddy below? (Buddy must be at least 14 years of age on 2/10/2023 AND attend a training session)
Buddy First Name
Buddy Last Name
Buddy Cell Phone
Please select whether you want to wear one of the following
What are this Guest's communication needs?
What are this Guest's mobility needs?
What are this Guest's food needs?
Please List All Allergies: (food and contact) and whether this guest will have an Epi-Pen on site.
Guest Allergies
Would this Guest prefer a Quiet entrance with no flashes or applause?
Guest Allergies Select NO YES
Does this Guest have any triggers of which we should be aware (being touched, loud noises, etc.)?
Guest Triggers
On This Date
I have entered into the Indemnification Agreement below and have affixed my signature, signifying I have read and understand the significance of signing said Indemnification Agreement. I understand by entering into this Indemnification Agreement, I am waiving the right that I have or may have to make any and all claims against The Bridge Church, and the Tim Tebow Foundation, its agents, servants and employees, for any injury that I may incur while participating in Tim Tebow Foundation's A Night to Shine on 2/10/2023. I further understand that my participation is at my own risk, and I agree to indemnify and hold The Bridge Church and the Tim Tebow Foundation its agents, servants and employees harmless from any and all claims and/or liabilities which may arise as a result of my participation in the Tim Tebow Foundation's Night to Shine. I FURTHER UNDERSTAND THAT THE BRIDGE CHURCH AND THE TIM TEBOW FOUNDATION, AND ITS LIABILITY INSURANCE CARRIER, SHALL NOT BE RESPONSIBLE FOR PAYMENT OF ANY MEDICAL BILLS, EXPENSES, COSTS, FEES OR DAMAGES WHICH MAY RESULT IN CONNECTION WITH MY PARTICIPATION IN THE NIGHT TO SHINE. I FURTHER AGREE THAT I SHALL BE SOLELY RESPONSIBLE FOR PAYMENT OF ANY SUCH COSTS, EXPENSES, DAMAGES AND/OR MEDICAL BILLS OR FEES WHICH MAY ACCRUE AS A RESULT OF MY PARTICIPATION IN THE NIGHT TO SHINE, REGARDLESS OF WHETHER OR NOT I MAINTAIN MEDICAL AND/OR LIABILITY INSURANCE COVERAGE FOR THE BENEFIT OF MYSELF. I FURTHER AGREE THAT I SHALL INDEMNIFY, DEFEND AND HOLD HARMLESS, THE BRIDGE CHURCH AND THE TIM TEBOW FOUNDATION, ITS AGENTS, SERVANTS AND EMPLOYEES, FROM ANY AND ALL CLAIMS AND LIABILITIES INCLUDING BUT NOT LIMITED TO ATTORNEY'S FEES, WHICH MAY ACCRUE TO ANY AND ALL THIRD PARTIES AS A RESULT OF MY PARTICIPATION IN THE TIM TEBOW FOUNDATION'S NIGHT TO SHINE.
Electronic Signature of Guardian OR Guest (if over 18 and his or her own guardian); I attest that all information included herein is accurate and truthful, my name below acts as an electronic signature
Indemnification Signature
MEDIA RELEASE: By signing below, and for the good and valuable consideration of participating in an event hosted by The Bridge Church, and sponsored in part by or associated with the Tim Tebow Foundation, I hereby give my full and voluntary consent to Tim Tebow Foundation, Inc., ("TTF") a Georgia nonprofit corporation headquartered in Florida and The Bridge Church ("CHURCH"), a NJ 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 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.
Electronic Signature of Guardian OR Guest (if over 18 and his or her own guardian); I attest that all information included herein is accurate and truthful, my name below acts as an electronic signature
Media Release Signature
Submit
