*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 the medication.

Health Concerns and Needs

Caretaker Information

Medical & Liability Release Form

I/We, the undersigned Parent(s) do hereby authorize representation of First Christian Church of Herrin ("FCCH") as agent(s) for the undersigned. I/We hereby give permission for the agent of FCH to administer necessary First Aid and Medical Aid to our guest when deemed appropriate. I realize that every effort will be made to contact me before any emergency treatment is administered. If the leaders of FCCH cannot reach me, I give them permission to admit my child into the care facility nearest that location if necessary. I release the agents of FCCH from any claim that my child may have or that I may have against them as a result of injury or illness incurred during the course of participation in the event of activities.

I/We hereby give permission for the undersigned to ride in any vehicle designated by the adult in whose care the undersigned has been entrusted while attending and participating in activities sponsored by FCCH and the Tim Tebow Foundation. I/We further release FCCH, any of its ministries or leaders, and the Tim Tebow Foundation from any and all liability in the event of an accident en route during and/or returning from the above mentioned event. This agreement does not apply to claims for intentional misconduct or gross negligence.

Participation Waiver

I/We, hereby, give permission for the undersigned listed below to participate in the event listed above. I acknowledge that there are certain risks associated with the activities, including but not limited to, physical injury due to activity-related accidents, and physical injury due to transportation-related accidents, illness, or even death.

Media Rights Release

By signing below, and for the good and valuable consideration of participating in an event hosted by FCCH, and sponsored in part by or associated with the Tim Tebow Foundation, I hereby give my full consent to Time Tebow Foundation, Inc., ("TTF") a Georgia 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 FCCH, without royalty or other compensation now or in the future, all rights of every kind of character whatsover, in perpetuity, in and to any and all such recordings, along with any additional recordings I might provide to TTF and FCCH, and to any benefits inuring to TTF and FCCH as a result of its use of any of the foregoing recordings. Among other things, TTF and FCCH may, but are not required to, copy or reporduce 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 FCCH, for the advancement of TTF and FCCH's exempt charitable purposes. All permissions granted herein extend to any successor or assign of TTF and FCCH and bind me and my heirs, successofs, and assigns. I, hereby release and discharge and agree to hold harmless TTF and FCCH, 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.

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