WAITLIST for Night to Shine 2026 Honored Guest Registration

This is the waitlist registration for the 2026 Tim Tebow Night to Shine Prom hosted by Refuge Church! We will reach out to you as soon as possible if spaces open up.

Your name *

Email address *

Birthdate *

Age as of February 13, 2026 *

Gender *

Address *

Emergency Contact/Guardian during event (will be listed on guest's nametag) *

Emergency Contact Phone (will be listed on guest's nametag) *

Will guest need medication administered during the 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 medication.

Yes

Parent/Guardian

If you are a professional caregiver for the honored guest who resides in a facility/group home, you must be registered as a buddy.

Will parent(s)/guardian(s) be staying in the Respite Room during the event? *

Yes

Additional Honored Guest Information

We would love to make your Night to Shine experience the best it can possibly be. If you are comfortable sharing, please answer any of the following optional items that apply in order to help us offer the best support we can.

Health Concerns

Mobility Needs

Communication Needs

Sensory Issues/Concerns

Strobe lights, camera flashes, loud noises, etc.

Allergies

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

Food Needs

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

Honored Guest will be bringing their own food due to dietary needs: *

Yes

Additional Notes/Concerns you would like us to be aware of

Fun Fact About You

Caretaker Information

The caretaker listed below should be a person that is staying onsite, is the honored guest’s buddy, or is immediately available to provide support for any care needs the honored guest may have throughout the evening.

Caretaker Name(s) *

Caretaker Phone Number(s) *

Caretaker Relationship to Guest *

Does Honored Guest reside in a facility? *

Yes

Agency Director Name

Agency Director Cell Phone

Agency Employee/Buddy

Agency Employee/Buddy Cell Phone

This agency employee will be assigned as the buddy to the following honored guest:

Additional Notes or Concerns

Media Rights Release

Night to Shine Parent/Caretaker Media Rights Release *

By signing below, and for the good and valuable consideration of participating in an event
hosted by REFUGE 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 REFUGE CHURCH (“CHURCH”), a STATE 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.

Parent/Caretaker Agree and Accept *

By typing your name below, you agree to and accept the above release.

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