North Way Christian Community

Night to Shine - Guest

Please complete the form below for each participant.

Guest Information
*Last Name:
*First Name:
*Age as of 2/11/22:
*Gender:
*Address (Street, City, State, Zip):
*Email:
*Phone:
*Fun Fact About You:
*Primary Contact Name:
*Primary Contact Phone:
*Health Concerns:
*Special Communication Needs:
If yes please explain:
Sensory Issues/Concerns (strobe lights, camera flashes, loud noises, ect.):
*Allergies (Please list any that apply: foods, animals, latex, makeup, plants or pollen, etc.):
*I will be attending the Shine Thru (Drive Thru) Parade:
Shine Thru (Drive Thru) Parade
Friday, Feb. 11, 2022
5:30pm-7:30pm
Virtual Celebration
*Do you have access to the internet:
*Do you have access to a computer or tablet:
*If no, would you be able to borrow a computer or tablet from a friend or family member:
*Is there anything we can be praying for you for:
Parent/Caretaker Information
*Parent/Caretaker Name(s):
*Parent/Caretaker Phone:
Care Provider Agency Information - If Applicable
Care Provider Agency:
Care Provider Agency Phone:
Agency Chaperone (If Applicable):
Additional Notes:
Night to Shine Parent/Caretaker Media Rights Release

Signature required for both Guest AND their Parent/Guardian in attendance. 

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

AGREED TO AND ACCEPTED:

North Way Participation Agreement

I/We, ______________________________________________________________________________, parents/guardians/self of the above named participant give permission for them to participate in the event referenced above.  In the event that he/she is injured while under the care of North Way Christian Community and/or its representatives, and requires the attention of a licensed medical professional, I/We hereby consent to and will be financially responsible for any medical treatment as deemed necessary by a licensed medical professional.  I/We further agree to hold the licensed medical professional, the medical facility, North Way Christian Community and its representatives free and harmless of any and all claims, demands, obligations, or legal actions for damages arising from the authorization and/or provision of such treatment.  I/We fully understand the nature and any/all of this event and do hereby release North Way Christian Community and its representatives from any liability due to accident or injury incurred by or to my/our child/ward.


Tim Tebow Foundations WAIVER AND RELEASE OF LIABILITY 

IN CONSIDERATION OF the risk of injury that exists while participating in NIGHT TO SHINE (hereinafter the "Activity"); and 

IN CONSIDERATION OF my desire to participate in said Activity and being given the right to participate in same; 

I HEREBY, for myself, my heirs, executors, administrators, assigns, or personal representatives (hereinafter collectively, "Releasor," "I" or "me", which terms shall also include Releasor's parents or guardian if Releasor is under 18 years of age), knowingly and voluntarily enter into this WAIVER AND RELEASE OF LIABILITY and hereby waive any and all rights, claims or causes of action of any kind arising out of my participation in the Activity; and 

I HEREBY release and forever discharge the TIM TEBOW FOUNDATION, located at 7700 Square Lake Blvd, Jacksonville, Florida 32256, their affiliates, managers, members, agents, attorneys, staff, volunteers, heirs, representatives, predecessors, successors and assigns (collectively "Releasees"), from any physical or psychological injury that I may suffer as a direct result of my participation in the aforementioned Activity. 

I AM VOLUNTARILY PARTICIPATING IN THE AFOREMENTIONED ACTIVITY AND I AM PARTICIPATING IN THE ACTIVITY ENTIRELY AT MY OWN RISK. I AM AWARE OF THE RISKS ASSOCIATED WITH PARTICIPATING IN THIS ACTIVITY, WHICH MAY INCLUDE, BUT ARE NOT LIMITED TO: PHYSICAL OR PSYCHOLOGICAL INJURY, PAIN, SUFFERING, ILLNESS, DISFIGUREMENT, TEMPORARY OR PERMANENT DISABILITY (INCLUDING PARALYSIS), ECONOMIC OR EMOTIONAL LOSS, AND DEATH. I UNDERSTAND THAT THESE INJURIES OR OUTCOMES MAY ARISE FROM MY OWN OR OTHERS' NEGLIGENCE, CONDITIONS RELATED TO TRAVEL TO AND FROM THE ACTIVITY, OR FROM CONDITIONS AT THE ACTIVITY LOCATION(S). NONETHELESS, I ASSUME ALL RELATED RISKS, BOTH KNOWN AND UNKNOWN TO ME, OF MY PARTICIPATION IN THIS ACTIVITY. 

I FURTHER AGREE to indemnify, defend and hold harmless the Releasees against any and all claims, suits or actions of any kind whatsoever for liability, damages, compensation or otherwise brought by me or anyone on my behalf, including attorney's fees and any related costs. 

I FURTHER ACKNOWLEDGE that Releasees are not responsible for errors, omissions, acts or failures to act of any party or entity conducting a specific event or activity on behalf of Releasees. In the event that I should require medical care or treatment, I authorize the Tim Tebow Foundation to provide all emergency medical care deemed necessary, including but not limited to, first aid, CPR, the use of AEDs, emergency medical transport, and sharing of medical information with medical personnel. I further agree to assume all costs involved and agree to be financially responsible for any costs incurred as a result of such treatment. I am aware and understand that I should carry my own health insurance. 

I FURTHER ACKNOWLEDGE that this Activity may involve a test of a person's physical and mental limits and may carry with it the potential for death, serious injury, and property loss. I agree not to participate in the Activity unless I am medically able and properly trained, and I agree to abide by the decision of the Tim Tebow Foundation official or agent, regarding my approval to participate in the Activity. 

I HEREBY ACKNOWLEDGE THAT I HAVE CAREFULLY READ THIS "WAIVER AND RELEASE" AND FULLY UNDERSTAND THAT IT IS A RELEASE OF LIABILITY. I EXPRESSLY AGREE TO RELEASE AND DISCHARGE the Tim Tebow Foundation AND ALL OF ITS AFFILIATES, MANAGERS, MEMBERS, AGENTS, ATTORNEYS, STAFF, VOLUNTEERS, HEIRS, REPRESENTATIVES, PREDECESSORS, SUCCESSORS AND ASSIGNS, FROM ANY AND ALL CLAIMS OR CAUSES OF ACTION AND I AGREE TO VOLUNTARILY GIVE UP OR WAIVE ANY RIGHT THAT I OTHERWISE HAVE TO BRING A LEGAL ACTION AGAINST the Tim Tebow Foundation FOR PERSONAL INJURY OR PROPERTY DAMAGE. 

To the extent that statute or case law does not prohibit releases for ordinary negligence, this release is also for such negligence on the part of the Tim Tebow Foundation, its agents, and employees. 

I agree that this Release shall be governed for all purposes by Florida law, without regard to any conflict of law principles. This Release supersedes any and all previous oral or written promises or other agreements.

In the event that any damage to equipment or facilities occurs as a result of my or my family's or my agent's willful actions, neglect or recklessness, I acknowledge and agree to be held liable for any and all costs associated with any such actions of neglect or recklessness. 

THIS WAIVER AND RELEASE OF LIABILITY SHALL REMAIN IN EFFECT FOR THE DURATION OF MY PARTICIPATION IN THE ACTIVITY, DURING THIS INITIAL AND ALL SUBSEQUENT EVENTS OF PARTICIPATION. 

THIS AGREEMENT was entered into at arm's-length, without duress or coercion, and is to be interpreted as an agreement between two parties of equal bargaining strength. Both Participant, __(named above)_ and the Tim Tebow Foundation agree that this agreement is clear and unambiguous as to its terms, and that no other evidence shall be used or admitted to alter or explain the terms of this agreement, but that it will be interpreted based on the language in accordance with the purposes for which it is entered into. 

In the event that any provision contained within this Release of Liability shall be deemed to be severable or invalid, or if any term, condition, phrase or portion of this agreement shall be determined to be unlawful or otherwise unenforceable, the remainder of this agreement shall remain in full force and effect. If a court should find that any provision of this agreement to be invalid or unenforceable, but that by limiting said provision it would become valid and enforceable, then said provision shall be deemed to be written, construed and enforced as so limited. 

I, THE UNDERSIGNED PARTICIPANT, AFFIRM THAT I AM OF THE AGE OF 18 YEARS OR OLDER, AND THAT I AM FREELY SIGNING THIS AGREEMENT. I CERTIFY THAT I HAVE READ THIS AGREEMENT, THAT I FULLY UNDERSTAND ITS CONTENT AND THAT THIS RELEASE CANNOT BE MODIFIED ORALLY. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY AND A CONTRACT AND THAT I AM SIGNING IT OF MY OWN FREE WILL.

Must be signed by Parent/Guardian if Participant/Guest is under 18. 


Parent/Caretaker Information
*Name/Signature of Parent/Caretaker in Agreement with Media Release, NW Participation Agreement and TTF Waiver:
*Date:
OR Signature of Guest if over 18 in agreement with Media Release, NW Participation Agreement and TTF Waiver:
Date Signed: