Miss Gulf Coast USA Pageant 2021

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Email *

Crowning of Miss Texas USA 2020

Crowning of Miss Texas Teen USA 2020

Division *

Miss Gulf Coast- ALL BIRTHDATES DURING 1993-2002

Miss Gulf Coast Teen- ALL BIRTHDATES DURING 2002-2006

Name *

Age *

Birthdate *

YYYY

Cell Phone *

Permanent Address (include city, state, zip) *

Mailing Address if different (include city, state, zip) *

School/College *

Grade/Year *

Are you a previous contestant *

Yes

Mom/Guardian Name (if a minor) *

Mom/Guardian Email (if a minor) *

Mom/Guardian Cell (if a minor) *

Dad/Guardian Name (if a minor) *

Dad/Guardian Email (if a minor) *

Are you allergic to any medications or foods? *

Yes

please list if yes

Do you have any ongoing or chronic medical conditions? *

Yes

please explain if yes

Do you have any medical or physical conditions that might limit your ability to participate in any portion of the stage competition? *

We (I) hereby consent to allow Texas Crown Productions, LLC to select a hospital, clinic, or other medical facility that shall be authorized to diagnose and treat your daughter in the case of emergency that may arise during the production of the pageant. In addition, we (I) hereby release Texas Crown Production, LLC from all liability therefrom. *

Emergency Contact name/relationship *

Emergency contact phone number *

List any and all medications that you are currently taking (prescription or non-prescription) *

Do you currently hold a title approved by the state Miss Texas office? *

Yes

Are you currently a titleholder with a commitment under the direction of another Miss Texas or Miss Texas Teen approved recruiter? *

Yes

Were you recruited to participate by another contestant competing in this pageant? *

Yes

If answer to yes above, please list the name of the contestant that recruited you to participate.

Do you currently hold a title with another organization that requires an obligation to fulfill? If yes, what title and organization?

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