Attend Night to Shine

Guest Information
Guest Name

Will be listed on guest’s nametag

Will be listed on guest’s nametag

Guest Transportation 
Guest Accommodations
Wheelchair/accessibility device dependent? 
Special communication needs? 

Such as strobe lights, camera flashes, loud noises, etc.

Please list any that apply: foods, animals, latex, makeup, plants or pollen, etc.

Any special food needs? 

Food cut-up or pureed, gluten-free, dairy-free, nut-free, etc.

Will guest 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.
Parent/Caretaker Information
Parent/Guardian/Caretaker Will:
  • The Respite Room is a private area where parents/caretakers of guests can spend the evening enjoying food, entertainment and rest while remaining onsite during the event.

Please limit to two Parents/Guardians/Caretakers:

Parent/Guardian/Caretaker 1
Parent/Guardian/Caretaker 2
Care Provider Agency Information
Agency chaperone
  • The Respite Room is a private area where parents/caretakers of guests can spend the evening enjoying food, entertainment and rest while remaining onsite during the event.

Please fill out the additional fields below so that we can request that a background check be run.

Media Releases

A signed media release is required for all event attendees, including guests and any parents/guardians/caretakers who will remain on the premises. A parent/guardian must sign on behalf of any guests who are under 18.

By entering my name below, and for the good and valuable consideration of participating in an event hosted by Willamette Christian 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 Willamette Christian Church (“WCC”), an Oregon 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 WCC, 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 WCC, and to any benefits inuring to TTF and WCC as a result of its use of any of the foregoing recordings. Among other things, TTF and WCC 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 WCC, for the advancement of TTF and WCC’s exempt charitable purposes. All permissions granted herein extend to any successor or assign of TTF and WCC and bind me and my heirs, successors, and assigns. I, hereby release and discharge and agree to hold harmless TTF and WCC, 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.

Night to Shine Guest

Onsite Parent/Guardian/Caretaker