***PLEASE NOTE*** THIS FORM WILL REGISTER YOU FOR THE SIKESTON MISSOURI NIGHT TO SHINE EVENT ONLY!
THIS REGISTRATION IS FOR THE SIKESTON MISSOURI NIGHT TO SHINE EVENT ONLY
Parent/Caretaker Information
Care Provider Agency Information - If Applicable
If attending as part of a group, please include agency or company name.
2021 Virtual Night To Shine Participant Media Rights Release
By signing below, and for the good and valuable consideration of participating in an event hosted by Sikeston First Assembly of God, 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 Sikeston First Assembly of God, a MO 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 Sikeston First Assembly of God, 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 Sikeston First Assembly of God, and to any benefits inuring to TTF and Sikeston First Assembly of God as a result of its use of any of the foregoing recordings. Among other things, TTF and Sikeston First Assembly of God 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 Sikeston First Assembly of God, for the advancement of TTF and First Assembly of God’s exempt charitable purposes. All permissions granted herein extend to any successor or assign of TTF and Sikeston First Assembly of God and bind me and my heirs, successors, and assigns. I, hereby release and discharge and agree to hold harmless TTF and Sikeston First Assembly of God, 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.
Indemnity and Release Form 2021 - Sikeston First Assembly of God
I, the undersigned, wish to voluntarily participate in the (NTS) Night to Shine prom for special needs individuals sponsored by the Tim Tebow foundation.
In consideration for being permitted to participate in the NTS, in the city of Miner, the state of MO, and country of USA, beginning the 12th day of February, 2021, I, the undersigned, fully recognizing the dangers and hazards inherent in the NTS, and any related transportation, including personal injury, property damage, or wrongful death, as well as the unknown dangers and hazards which may arise in the course of my participation in the NTS,
do hereby voluntarily:
Agree, for myself, my heirs and my personal representative, to defend, hold harmless, indemnify, release and forever discharge, to the broadest extent allowed by law, Sikeston First Assembly of God and the Tim Tebow Foundation, its trustees, officers, employees, agents, insurers, successors, assigns, from and against any and all claims, demands, actions, or causes of action on account of any damage to real or personal property or any personal injury or death that may result from my participation in the above NTS.
I have read this release, I understand it fully, I understand that it is legally binding, and I understand that, among other things, I am agreeing to indemnify Sikeston First Assembly of God and the Tim Tebow Foundation, for injuries, damages or losses I may cause and giving up rights to sue Sikeston First Assembly of God and the Tim Tebow Foundation for injuries, damages or losses I may incur.
Caretaker/Parent Media Rights Release
By signing below, and for the good and valuable consideration of participating in an event hosted by Sikeston First Assembly of God, 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 Sikeston First Assembly of God, a MO 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 Sikeston First Assembly of God, 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 Sikeston First Assembly of God, and to any benefits inuring to TTF and Sikeston First Assembly of God as a result of its use of any of the foregoing recordings. Among other things, TTF and Sikeston First Assembly of God 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 Sikeston First Assembly of God, for the advancement of TTF and Sikeston First Assembly of God’s exempt charitable purposes. All permissions granted herein extend to any successor or assign of TTF and Sikeston First Assembly of God and bind me and my heirs, successors, and assigns. I, hereby release and discharge and agree to hold harmless TTF and Sikeston First Assembly of God, 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.
