MAKE 'm SMILE Minnesota Smile Maker Registration

Minnesota MAKE 'm SMILE Smile Maker Registration

"*" indicates required fields

Your Name*

First Last

Organization/Group Name

Address*

Street Address Unit # City State / Province / Region ZIP / Postal Code

Address Type*

Website

Cell Phone*

Office Phone (if applicable)

Email*

Enter Email Confirm Email

Please describe the entertainment you provide.*

Will anyone in your group be coming as a costumed character?*

Yes

Please attach picture of character you plan on bringing to Make 'm Smile.*

Drop files here or

Accepted file types: jpg, png, Max. file size: 800 MB.

To ensure all characters are age appropriate and that there are not duplicate characters, approval is required.

How many people are in your entertainment group?*

Please list past experience.*

Other Comments

Reference Information

We ask for one reference that can verify your entertainment credibility and capability.

Reference Name*

First Last

Organization/Business Name*

Phone*

Email*

Acknowledgement, Release, & Waiver*

I agree to below:

As a Smile Maker for Make 'm Smile, I grant permission for Nathaniel's Hope and Living Word Church to use any images or video shot by Nathaniel's Hope or Living Word Church photographers and others for promotional purposes.
Release: Smile Maker is participating in Make 'm Smile ("Activity") voluntarily, and does hereby release and forever discharge and hold harmless Nathaniel's Hope, Living Word Church, and its successors and assigns from any and all liability, claims, and demands of whatever kind or nature, either in law or in equity, which arise or may hereafter arise from Smile Maker's participation in the Activity. Smile Maker understands that this release discharges Nathaniel's Hope and Living Word Church from any liability or claim that Smile Maker may have against Nathaniel's Hope or Living Word Church with respect to any bodily injury, personal injury, illness, death or property damage that may result from Smile Maker's participation with the Activity, whether caused by the gross negligence of Nathaniel's Hope, Living Word Church or its officers, directors, employees, agents, or otherwise. Smile Maker also understands that Nathaniel's Hope and Living Word Church does not assume any responsibility for or obligation to provide financial assistance or other assistance, including but not limited to medical, health, or disability insurance in the event of injury or illness. Smile Maker understands that, except as otherwise agreed to by Nathaniel's Hope and Living Word Church in writing; Nathaniel's Hope nor Living Word Church does not carry or maintain health, medical, or disability insurance coverage for any Smile Maker. Each Smile Maker is expected and encouraged to obtain his or her own medical or health insurance coverage.
Other: Smile Maker expressly agrees that this Release is intended to be as broad and inclusive as permitted by laws of the State of Florida, and that this Release shall be governed by and interpreted in accordance with the laws of the State of Florida. Smile Maker agrees that in the event that any clause or provision of this Release shall be held to be invalid by any court of competent jurisdiction, the invalidity of such clause or provision shall not otherwise affect the remaining provision of this Release which shall continue to be enforceable.

Date*

Signature*

Please type your name.

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