Name *

First Name

Last Name

Gender *

Male

Female

Phone *

(###)

###

####

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Are you under 18? *

Yes

No

Parent/Guardian Name

(Please fill out only if under 18)

First Name

Last Name

Parent/Guardian Phone

(###)

###

####

Former Special Needs Experience

Please check all that apply.

Fluent in American Sign Language (ASL)

Special Education Teacher/Paraeducator

Heathcare Professional

Other

Have you volunteered at previous CCE Night to Shine or Summer Sizzle events? *

Yes

No

Group or Organization *

Please indicate if you are volunteering as part of a larger group or organization. If none, please select "Not Applicable".

Not Applicable

Calvary Chapel Eastside

Bellevue Sarang Church

YoungLife/Capernaum

Newport High School

Summit Classical Christian School (SCCS)

Other

Emergency Contact Name *

First Name

Last Name

Emergency Contact Phone *

(###)

###

####

By submitting my registration to volunteer, and for the good and valuable consideration of participating in an event hosted by CALVARY CHAPEL EASTSIDE, I hereby give my full consent to Calvary Chapel Eastside (“CCE”), a Washington 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 CCE, 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 CCE, and to any benefits inuring to CCE as a result of its use of any of the foregoing recordings. Among other things, CCE may, but is 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 CCE, for the advancement of CCE’s exempt charitable purposes. All permissions granted herein extend to any successor or assign of CCE and bind me and my heirs, successors, and assigns. I hereby release and discharge and agree to hold harmless CCE, 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 recording or use of the recordings. This release shall be construed, interpreted, and governed in accordance with the laws of the State of Washington, 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. *

Yes, I AGREE.