Volunteer Permission Slip (Volunteers Under Age 18) Volunteer Permission Slip (Volunteers Under Age 18)Volunteer Registration Permission Slip (Minor Under 18) + Parent Consent Agreement I am the parent/legal guardian of the above named minor.Minor may work until 11:00 p.mParent First NameParent Last NameVolunteer Information (Minor Under 18)First NameLast NameEmailDOBGender- Select -MaleFemaleAddressAddress Line 1Address Line 2CityStateZip CodePhone/MobileParent / Guardian Phone (Home)Parent / Guardian Phone (Cell)Volunteer Role Requested (Please choose your top three choices. We will consider your request but cannot guarantee a specific role):Bathroom AttendantBuddyCoat CheckFloatersFlowers/CrownsFood PrepFood ServiceHair, Makeup and Shoeshine (please let us know if you are a hairdresser or makeup artist)Medical (please let us know if you are a certified EMS/EMT or practicing doctor or nurse)Paparazzi on Red CarpetParkingRegistrationRespite RoomSafetySensory RoomSet-UpTear DownTransportationWhere I Am Needed Most MEDIA AND LIABILITY RELEASE AGREEMENT EVENT: Night to Shine Event hosted by Pittsboro United Methodist Church (PUMC) at the Lizton Lodge, sponsored in part by or associated with the Tim Tebow Foundation (TTF). By signing below, I, the undersigned participant, hereby acknowledge and agree to the terms and conditions outlined in this Media and Liability Release Agreement ("Agreement") with the understanding that in consideration for my participation in the Night to Shine event, the Tim Tebow Foundation, Inc. (TTF), Pittsboro United Methodist Church (PUMC), and The Lizton Lodge (hereinafter collectively referred to as "Releases") are granted certain rights and releases from liability. MEDIA RELEASE: I hereby give my full consent to TTF, PUMC, and The Lizton Lodge 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 during the Night to Shine event. I grant these rights without any royalty or other compensation now or in the future. I also grant the aforementioned entities all rights of every kind and character whatsoever, in perpetuity, in and to any and all recordings made during the event, along with any additional recordings I might provide, for the sole benefit and at the sole discretion of TTF and PUMC for the advancement of their exempt charitable purposes. WAIVER AND RELEASE OF LIABILITY: In exchange for the opportunity to participate in the Night to Shine event, I hereby waive any and all rights, claims, or causes of action arising out of my participation, including, but not limited to, any injury, accident, illness, or other occurrence. I release and discharge TTF, PUMC, and The Lizton Lodge, along with their directors, officers, employees, volunteers, and independent contractors, from any claims or damages, including defamation, violation of rights or privacy, or publicity, arising from or associated with the recordings or use of recordings. I further release and discharge TTF, PUMC, and The Lizton Lodge, along with their directors, officers, employees, volunteers, and independent contractors, from any claims relating to any physical or psychological injury which I may suffer as a direct or indirect result of my participation in the Night to Shine event. ASSUMPTION OF RISK: I acknowledge that I am voluntarily participating in the Night to Shine event entirely at my own risk. I am aware of the risks associated with the participation in this activity, including, but not limited to, physical or psychological injury, pain, suffering, illness, disfigurement, temporary or permanent disability, 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. GOVERNING LAW: This release shall be construed, interpreted, and governed in accordance with the laws of the State of Florida. Should any provision of this release be determined invalid, such invalidity does not affect any of the remaining provisions. I affirm that I am of full age and have the right to contract in my own name. Do you agree to Media & Liability Release- Select -YesNoRemit form to: Pittsboro United Methodist Church Office – Attn Night To Shine 227 E Main St, Pittsboro, IN 46167 This form must be completed and kept at the location where minor is volunteering.Agree and Submit