Night to Shine 2022 St. Charles Missouri

RESPITE ROOM REGISTRATION

The Respite Room is an area at Messiah set aside for parents and caregivers of Honored Guests attending Night to Shine. Two people per Honored Guest are allowed to make a reservation for the Respite Room. The Respite Room is open from 6:00-9:00 p.m. Refreshments will be provided.

Name of Honored Guest attending Night to Shine: *

First

Last

Name of Parent/Caregiver #1 enjoying Respite Room: *

First

Last

Dietary Restrictions (if applicable):

Name of Parent/Caregiver #2 enjoying Respite Room (if applicable):

First

Last

Dietary Restrictions (if applicable):

Additional Notes/Concerns You Would Like Us To Be Aware Of?

GENERAL LIABILITY WAIVER - Messiah Lutheran Church & School General Liability Waiver: In consideration of my participation, I agree and understand that I assume the risks inherent in my participation of this event, and with full knowledge of the risks, I agree to hold harmless Messiah Lutheran Church and its employees and assigned representatives from claims arising or related to my participation. I hereby accept all injury and risk to health that may result from such participation and release Messiah Lutheran Church, its employees and representatives from any and all liability to me or for all and any claims and causes of action for loss of or damage to my property and for any and all illness or injury to my person, including death, that may result from or occur during my participation in the event or means of transportation to or from the event, whether caused by negligence of Messiah Lutheran Church, its employees or representatives or otherwise. I consent and give permission for emergency medical care that may be needed as a result of my participation. Agreed to and accepted: *

First

Last

Please sign FULL GUEST NAME; if under 18, PARENT/GUARDIAN should sign.

Parent/Caregiver #1 Signature: *

First

Last

Please sign FULL PARENT/CAREGIVER NAME

Parent/Caregiver #2 Signature (if applicable):

First

Last

Please sign FULL PARENT/CAREGIVER NAME

MEDIA TERMS & CONDITIONS - Night to Shine Media Rights Release: By signing below, and for the good and valuable consideration of participating in an event hosted by Messiah Lutheran 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 Messiah Lutheran Church (“CHURCH”), a Missouri 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 CHURCH, 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 CHURCH, and to any benefits inuring to TTF and CHURCH as a result of its use of any of the foregoing recordings. Among other things, TTF and CHURCH 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 CHURCH, for the advancement of TTF and CHURCH’s exempt charitable purposes. All permissions granted herein extend to any successor or assign of TTF and CHURCH and bind me and my heirs, successors, and assigns. I, hereby release and discharge and agree to hold harmless TTF and CHURCH, 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: *

First

Last

Please sign FULL GUEST NAME; if under 18, PARENT/GUARDIAN should sign.

Parent/Caregiver #1 Signature: *

First

Last

Please sign FULL PARENT/CAREGIVER NAME

Parent/Caregiver #2 Signature (if applicable):

First

Last

Please sign FULL PARENT/CAREGIVER NAME

RESPITE ROOM REGISTRATION

The Respite Room is an area at Messiah set aside for parents and caregivers of Honored Guests attending Night to Shine. Two people per Honored Guest are allowed to make a reservation for the Respite Room. The Respite Room is open from 6:00-9:00 p.m. Refreshments will be provided.

Name of Honored Guest attending Night to Shine: *

First

Last

Name of Parent/Caregiver #1 enjoying Respite Room: *

First

Last

Dietary Restrictions (if applicable):

Name of Parent/Caregiver #2 enjoying Respite Room (if applicable):

First

Last

Dietary Restrictions (if applicable):

Additional Notes/Concerns You Would Like Us To Be Aware Of?

First

Last

Please sign FULL GUEST NAME; if under 18, PARENT/GUARDIAN should sign.

Parent/Guardian #1 Signature: *

First

Last

Please sign FULL PARENT/CAREGIVER NAME

Parent/Guardian #2 Signature (if applicable):

First

Last

Please sign FULL PARENT/CAREGIVER NAME

First

Last

Please sign FULL GUEST NAME; if under 18, PARENT/GUARDIAN should sign.

Parent/Guardian #1 Signature: *

First

Last

Please sign FULL PARENT/CAREGIVER NAME

Parent/Guardian #2 Signature (if applicable):

First

Last

Please sign FULL PARENT/CAREGIVER NAME

Phone

5911 MO-94, St. Charles, MO 63304
Church: 636.926-9773 | School: 636 329-1096

PODCAST

Worship Times

Worship with us in-person on
Sundays at 9:00 & 10:30AM (CST).
9:00 service is livestreamed and
then available on demand.

Stay in the Loop

RESPITE ROOM REGISTRATION

The Respite Room is an area at Messiah set aside for parents and caregivers of Honored Guests attending Night to Shine. Two people per Honored Guest are allowed to make a reservation for the Respite Room. The Respite Room is open from 6:00-9:00 p.m. Refreshments will be provided.

RESPITE ROOM REGISTRATION

The Respite Room is an area at Messiah set aside for parents and caregivers of Honored Guests attending Night to Shine. Two people per Honored Guest are allowed to make a reservation for the Respite Room. The Respite Room is open from 6:00-9:00 p.m. Refreshments will be provided.

PODCAST

Worship Times

Stay in the Loop

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