Night to Shine Wait List Guests 2026

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Guest Information
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Date of Birth (Must be 14 by February 7, 2026) REQUIRED Please fill out this field. Please enter a date.
- Age Please enter valid data.
- Gender REQUIRED Please fill out this field.
- Fun Fact about you (Guest): REQUIRED Please fill out this field. Please enter valid data.
- What is the guest’s favorite song for Karaoke and the DJ? Please enter valid data.
- Health Concerns: Please enter valid data.
- Special Communication Needs: REQUIRED Please fill out this field.
- Sensory Issues/Concerns (strobe lights, camera flashes, loud noises, etc.): REQUIRED Please fill out this field.
- If yes, please explain: Please enter valid data.
- Allergies (Please list any that apply: foods, animals, latex, makeup, plants or pollen, etc.): REQUIRED Please fill out this field.
- If yes, please list allergies: Please enter valid data.
- Is the Guest able to use the restroom by themselves? (If they cannot, a parent or caretaker will remain on site in Parent Room to assist in bathroom care, since none of our volunteers will be permitted to render aid for this).. REQUIRED Yes No Please fill out this field.
- Is there anything we can be praying about for you?
Parent/Caretaker Information
- Parent/Caretaker Name: Please enter valid data.
- Email REQUIRED Please fill out this field. Please enter an email address.
- Parent/Caregiver Phone Number Maximum 20 characters Please enter a phone number.
- Will you be bringing a buddy/escort to stay with you at the event? REQUIRED Yes (please complete name and info below) No Please fill out this field.
- If yes, please complete buddy info below:
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Email Please enter an email address.
- Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
- Please choose one: REQUIRED I will be the buddy to my registered guest. I will stay in the caregivers room I will drop off and pick up at 9:00 pm. Please fill out this field.
Care Provider Agency Information - If Applicable
- Care Provider Agency: (If attending as a part of a group, please include agency or company name) Please enter valid data.
- Care Provider Agency Contact Phone Number Maximum 20 characters Please enter a phone number.
- Name of Agency Chaperone (if applicable) Please enter valid data.
- Additional Notes or Concerns:
Participant Media Release (Parent/Caretaker sign if participant under 18)
- By signing below, and for the good and valuable consideration of participating in an event hosted by Diocese of St. Augustine/ Erik T. Pohlmeier/ St. Luke Catholic 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 Diocese of St. Augustine/ Erik T. Pohlmeier/ St. Luke Catholic Church (“Diocese of St. Augustine/ Erik T. Pohlmeier/ St. Luke Catholic 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 Diocese of St. Augustine/ Erik T. Pohlmeier/ St. Luke Catholic 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 Diocese of St. Augustine/ Erik T. Pohlmeier/ St. Luke Catholic Church, and to any benefits inuring to TTF and Diocese of St. Augustine/ Erik T. Pohlmeier/ St. Luke Catholic Church as a result of its use of any of the foregoing recordings. Among other things, TTF and Diocese of St. Augustine/ Erik T. Pohlmeier/ St. Luke Catholic Church may, but are not 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 Diocese of St. Augustine/ Erik T. Pohlmeier/ St. Luke Catholic Church, for the advancement of TTF and Diocese of St. Augustine/ Erik T. Pohlmeier/ St. Luke Catholic Church’s exempt charitable purposes. All permissions granted herein extend to any successor or assign of TTF and Diocese of St. Augustine/ Erik T. Pohlmeier/ St. Luke Catholic Church and bind me and my heirs, successors, and assigns. I, hereby release and discharge and agree to hold harmless TTF and Diocese of St. Augustine/ Erik T. Pohlmeier/ St. Luke Catholic 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 Please select this field.
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Date REQUIRED Please fill out this field. Please enter a date.
- Signature of Participant (if over 18) Please enter valid data.
- Signature of Parent/Caretaker (if participant is under age 18) Please enter valid data.
- Address REQUIRED Please fill out this field. Please enter valid data.
- City/State/Zip Please enter valid data.
- Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
- Email REQUIRED Please fill out this field. Please enter valid data.
Parent/Caregiver Media Release
- By signing below, and for the good and valuable consideration of participating in an event hosted by Diocese of St. Augustine/ Erik T. Pohlmeier/ St. Luke Catholic 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 Diocese of St. Augustine/ Erik T. Pohlmeier/ St. Luke Catholic Church (“Diocese of St. Augustine/ Erik T. Pohlmeier/ St. Luke Catholic 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 Diocese of St. Augustine/ Erik T. Pohlmeier/ St. Luke Catholic 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 Diocese of St. Augustine/ Erik T. Pohlmeier/ St. Luke Catholic Church, and to any benefits inuring to TTF and Diocese of St. Augustine/ Erik T. Pohlmeier/ St. Luke Catholic Church as a result of its use of any of the foregoing recordings. Among other things, TTF and Diocese of St. Augustine/ Erik T. Pohlmeier/ St. Luke Catholic Church may, but are not 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 Diocese of St. Augustine/ Erik T. Pohlmeier/ St. Luke Catholic Church, for the advancement of TTF and Diocese of St. Augustine/ Erik T. Pohlmeier/ St. Luke Catholic Church’s exempt charitable purposes. All permissions granted herein extend to any successor or assign of TTF and Diocese of St. Augustine/ Erik T. Pohlmeier/ St. Luke Catholic Church and bind me and my heirs, successors, and assigns. I, hereby release and discharge and agree to hold harmless TTF and Diocese of St. Augustine/ Erik T. Pohlmeier/ St. Luke Catholic 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 Please select this field.
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Date REQUIRED Please fill out this field. Please enter a date.
- Signature of Parent/Caretaker Please enter valid data.
- Address Please enter valid data.
- City/State/Zip Please enter valid data.
- Phone Number Maximum 20 characters Please enter a phone number.
- Email REQUIRED Please fill out this field. Please enter valid data.
DOSA Parent/Caregiver PARTICIPATION AGREEMENT AND RELEASE
- FOR ADULT CAREGIVERS Attending With Guest ONLY - (If not applicable, please click the AGREED TO AND ACCEPTED box and type NA in fields)
  I, the undersigned, do waive and release the Diocese of St. Augustine, and their owned entities, corporate members, employees, officers, directors and agents ("Released Parties") from any expenses, costs, claims, or liability for any injury or damages I may incur which are not due to the gross negligence of the released parties, and in any way associated with my participation in volunteer activities.
  I understand that my volunteer activities involve some risk, and I hereby agree to assume such risk as a condition of my acceptance and participation in these activities.
  I hereby grant the Released Parties full authority to take whatever actions they may consider in their sole discretion to be warranted under the circumstances concerning my health and safety and I fully absolve the Released Parties from any liability or costs associated with such decisions or actions that may be taken in connection therewith. I authorize the Released Parties, at their discretion, to place me, at my own expense and without further consent, in a hospital that is readily available and/or to place me in the hands of a physician for treatment, should the need arise.
  AGREED TO AND ACCEPTED Please select this field.
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Date REQUIRED Please fill out this field. Please enter a date.
- Signature of Parent/Caretaker Please enter valid data.
- Emergency Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
- Name of Participant: Please enter valid data.
DOSA Minor Caregiver PARTICIPATION AGREEMENT AND RELEASE
- FOR MINOR BUDDIES/CAREGIVERS ONLY - (If not applicable, please click the AGREED TO AND ACCEPTED box and type NA in fields)
  I certify that I am the parent/legal guardian of the above-signed applicant, and that I have read the foregoing release and examined the information in the description. I hereby join in each and every part of the Release (including such part as may subject me to personal financial responsibility), and hereby relinquish any rights that I may have against the Released Parties as set forth above, both in my own behalf and in my capacity as legal representative (as applicable) of the participant.
  AGREED TO AND ACCEPTED Please select this field.
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Date REQUIRED Please fill out this field. Please enter a date.
- Signature of Parent of Minor Volunteer Please enter valid data.
- Emergency Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
- Name of Night to Shine Guest Associated with Minor Volunteer: REQUIRED Please fill out this field. Please enter valid data.

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