Back to School Registration

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Free dinner provided for pre-registered participants.

Emergency Contact

Media Release

I hereby grant the Light the Night Ministries, its directors, officers, employees, agents, and designers (collectively “LTN”) non-revocable permission to capture my image and likeness in videotapes, motion pictures, recordings, or any other media (collectively “Images”). I acknowledge that LTN will own such Images and further grant the LTN permission to copyright, display, publish, distribute, use, modify, print and reprint such Images in any manner whatsoever related to LTN business, including without limitation, publications, advertisements, brochures, web site images, or other electronic displays and transmissions thereof. I further waive any right to inspect or approve the use of the Image by the LTN prior to its use. I forever release and hold the LTN harmless from any and all liability arising out of the use of the Images in any manner or media whatsoever, and waive any and all claims and causes of action relating to use of the Images, including without limitation, claims for invasion of privacy rights or publicity.

I give my child listed in this form permission to attend the Back to School event by my signature in the box above.