Guest Registration

Select Event *

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First Name *

Last Name *

Name for nametag *

Date of Birth *

Gender *

Address *

City *

State *

ZIP Code *

Email Address *

Phone Number *

Caregiver Contact Name During Night To Shine *

Caregiver Contact Phone *

Emergency Contact Name *

Emergency Contact Phone *

If there is no answer, type "None" in the fields

Is there anything we can be praying about for you? *

Additional Notes You Would Like Us to Be Aware Of *

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.

Food Needs (food cut-up or pureed, gluten free, dairy free, nut free, etc.)? *

Allergies: list any that apply (foods, animals, latex, makeup, plants, pollen, etc.) *

Sensory concerns: (e.g., elopement, strobe lights, camera flashes, loud noises) *

Special communication needs *

Fun fact about your guest *

Wheelchair or accessibility device dependent *

How will the guest be transported? *

First and Last Name of Buddy Request (If possible) *

If enjoying Respite Room, please limit to 2 Parents or Caregivers

Name 1 *

Name 2 *

*The Respite Room is a private area where parents/caretakers of guests can spend the evening enjoying food, entertainment, activities, and rest while remaining onsite during Night to Shine.

Care Provider/Group Agency Information

Care Provider Group Agency (If registering as a part of a group, please include agency or company name) *

Care Provider/Agency Phone *

Group Agency Chaperone (If Applicable) *

Group Agency Chaperone Cell Phone *

Media & Liability Release:

I acknowledge that participation in Night to Shine involves inherent risks, including but not limited to potential exposure to the COVID-19 virus. I understand and voluntarily accept these risks for myself and/or any guest(s) I am responsible for attending with me.

I recognize that maintaining a six-foot distance from other attendees throughout the event may not be feasible. I understand that this Accident Waiver and Release of Liability will be used by the event's sponsors, organizers, and affiliated parties, and will apply to all aspects of my participation, including travel to and from the event.

On behalf of myself, my guests, students, heirs, assigns, executors, administrators, and next of kin, I hereby:

Waive, release, and discharge the Night to Shine event sponsored by the Tim Tebow Foundation, Big House Church, Houston Northwest Church, and all affiliated directors, officers, volunteers, representatives, and agents from any and all claims, liabilities, losses, damages, or causes of action of any kind that may arise from my participation in this event; and
Agree to indemnify and hold harmless all parties listed above from any and all such claims or liabilities that may be asserted by me or any third party in connection with my participation.

I further understand and consent that photographs or videos may be taken during the event and that these images may be used by the event organizers, sponsors, and their assigns for promotional, marketing, or other legitimate purposes. I hereby grant full permission for the use of my likeness in photo, video, or film format without compensation.

If the participant is under the age of 18, I certify that I am the legal parent or guardian of the minor named below and that I have the legal authority to grant this release on their behalf. I understand that I am assuming all risks and responsibilities associated with their participation in this event, and I agree to all terms of this waiver on behalf of the minor.

This waiver and release is intended to be interpreted as broadly and inclusively as permitted by applicable law. I have read this document carefully and understand that by signing or acknowledging this form, I am voluntarily waiving certain legal rights on behalf of myself and those I may represent.

(MUST be 18 Years or older) I have read and agree to the media and liability releases. *

By typing your name below you are agreeing to the above. Under 18 requires care provider permission. A care provider must sign below. *

Please review for errors before submitting this form.