The Star Boutique: Youth Registration
*Submitting this form does not confirm your acceptance to The Star Boutique. Your confirmation will come from a Star Boutique representative.
Parent/Guardian Name
Your answer
Contact Phone Number
Your answer
Email Address
Your answer
Are you representing an organization/shelter? If so, which one?
Youth Name *
Your answer
Youth Age *
Your answer
Youth Clothing Size *
Youth Dress Size
Youth Shoe Size
Does youth fall into any of the following categories?
Why are you referring this youth as a participant?
Your answer
I understand that my/youth's participation in this event will be photographed, videotaped and/ or recorded. I understand that my/youth's voice and image may be used on the STAR BOUTIQUE’s website, social media components and /or for promotional materials. I understand that I/youth will receive no compensation for my/youth' participation in this event or for the usage of my/youth's photographs or other media produced from this event. *
I grant permission for the STAR BOUTIQUE to publicly use my/youth's first name, image, voice and video recordings in connection with the STAR BOUTIQUE. This permission extends beyond the United States.
I grant permission for the STAR BOUTIQUE to use my/youth's voice and image only and understand that all information regarding my/youth's legal name and biographical material will be kept confidential.
I expressly release, the STAR BOUTIQUE , it's licensees, assignees, volunteers and others involved in this initiative, from any claim I/youth may have arising out of broadcast, exhibition,publication or promotion of this event.
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