registration page

Honored Guest Information:

First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.

Please list name as you would like it on your name tag:

First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.

Date of Birth REQUIRED Please fill out this field. Please enter a date.

Gender REQUIRED Male Female Please fill out this field.

Shirt Size REQUIRED Adult XS Adult S Adult M Adult L Adult XL Adult XXL Adult XXXL Please fill out this field.

Address REQUIRED Please fill out this field. Please enter valid data.

City REQUIRED Please fill out this field. Please enter valid data.

State REQUIRED Please fill out this field.

Zip REQUIRED Please fill out this field. Please enter a zip code.

Email REQUIRED Please fill out this field. Please enter an email address.

Phone Number REQUIRED Please fill out this field. Please enter a phone number.

Give a fun fact about you:

This information will help the buddy get to know the honored guest a little before they meet.

Special Communication Needs: REQUIRED Yes No Please fill out this field.

If yes, please explain Please enter valid data.

Sensory Issues/Concerns (strobe lights, camera flashes, loud noises, etc.) REQUIRED Please fill out this field.

Important Medical Information

Please list any health concerns REQUIRED Please fill out this field.

Wheelchair/Accessibility Device Dependent REQUIRED Yes No Please fill out this field.

If yes, please explain:

Allergies (Please list any that apply: Medical, foods, animals, latex, makeup, etc. Please note dinner is provided by Chick-fil-A): REQUIRED Please fill out this field.

Please list all medications (prescription and over the counter) taken by the honored guest. This is to make sure medical personnel can best treat the honored guests in the event of an emergency. REQUIRED Please fill out this field. Please enter valid data.

Will medication need to be administered during the event? REQUIRED Yes No Please fill out this field.

* 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.

Will the Honored Guest be dropped off/picked up by a parent/caretaker? REQUIRED Yes No Please fill out this field.

Will the Honored Guest be a part of a group that will be providing transportation to and from the event? REQUIRED Yes No Please fill out this field.

Emergency Contact Information (That will be available to be contacted during event)

First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.

Emergency Contact Phone Number REQUIRED Please fill out this field. Please enter a phone number.

Parent/Caretaker Information

First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.

Parent/Caretaker Phone Number REQUIRED Please fill out this field. Please enter a phone number.

Parent/Caretaker will be REQUIRED Dropping Guest off Enjoying the Parent Prom* Please fill out this field.

* The Parent Prom is a private area at the Presbyterian Church where parents/caretakers of guests can spend the evening enjoying food, entertainment and rest while remaining near guests during the event.

If attending Parent Prom, please list names of attendees. Please enter valid data.

Care provider Agency Information (If applicable)

Care Provider Agency Name (if attending as part of a group) Please enter valid data.

Care Provider Agency Phone Number Please enter a phone number.

Agency Chaperone Name (Chaperone is not required to stay with guest(s) unless required by Care Provider Agency) Please enter valid data.

Additional Notes or Concerns

Liabilty Release Waiver
Night to Shine Stillwater
February 10, 2023

I hereby waive First United Methodist Church and The Tim Tebow Foundation, its officers, employees, and volunteers from any liability of injury, loss or damage to personal property associated with activities participated in this event. I acknowledge that I understand the content of this document. I am aware that it is legally binding and I sign it out of my own free will.

I Agree Please select this field.

By signing below, and for the good and valuable consideration of participating in an eventhosted by First United Methodist 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 First United Methodist Church (“FUMC”), an Oklahoma 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 FUMC, 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 FUMC, and to any benefits inuring to TTF and FUMC as a result of its use of any of the foregoing recordings. Among other things, TTF and FUMC 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 FUMC, for the advancement of TTF and FUMC'S exempt charitable purposes.

All permissions granted herein extend to any successor or assign of TTF and FUMC and bind me and my heirs, successors, and assigns. I, hereby release and discharge and agree to hold harmless TTF and FUMC, 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. 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 CHURCH (“CHURCH”), a STATE 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 FUMC, 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 FUMC, and to any benefits inuring to TTF and FUMC as a result of its use of any of the foregoing recordings. Among other things, TTF and FUMC 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 FUMC, for the advancement of TTF and FUMC’s exempt charitable purposes. All permissions granted herein extend to any successor or assign of TTF and FUMC 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 to Shine Parent/Caretaker Media Rights Release

By signing below, and for the good and valuable consideration of participating in an event hosted by FUMC, 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 CHURCH (“CHURCH”), a STATE 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 FUMC, 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 FUMC, and to any benefits inuring to TTF and FUMC as a result of its use of any of the foregoing recordings. Among other things, TTF and FUMC 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 FUMC, for the advancement of TTF and FUMC’s exempt charitable purposes. All permissions granted herein extend to any successor or assign of TTF and FUMC 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 to Shine Parent/Caretaker Media Rights Release

By signing below, and for the good and valuable consideration of participating in an event hosted by FUMC, and sponsored in part by or associated with the Tim Tebow Foundation, I hereby give my full consent toTim Tebow Foundation, Inc., (“TTF”) a GeorgIa nonprofit corporation headquartered in Florida and CHURCH (“CHURCH”), a STATE 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/orvoice. Additionally, I hereby grant to TTF and FUMC, 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 FUMC, and to any benefits inuring to TTF and FUMC as a result of its use of any of the foregoing recordings. Among other things, TTF and FUMC 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 FUMC, for the advancement of TTF and FUMC’s exempt charitable purposes. All permissions granted herein extend to any successor or assign of TTF and FUMC 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

I Agree Please select this field.