Miss Heart of Texas USA Pageant 2020 Registration
Date: February 29th, 2020
Time: 7:00 pm
Location: Margaret W. Rudder Performing Arts Center at Rudder High School
3251 Austins Colony Parkway
Bryan, TX 77808
Email address *
Division *
Name *
Your answer
Age *
Your answer
Birthdate *
MM
/
DD
/
YYYY
Cell Phone *
Your answer
Permanent Address (include city, state, zip) *
Your answer
Mailing Address if different (include city, state, zip) *
Your answer
School/College *
Your answer
Grade/Year *
Your answer
Are you a previous contestant *
Mom/Guardian Name (if a minor) *
Your answer
Mom/Guardian Email (if a minor) *
Your answer
Mom/Guardian Cell (if a minor) *
Your answer
Dad/Guardian Name (if a minor) *
Your answer
Dad/Guardian Email (if a minor) *
Your answer
Are you allergic to any medications or foods? *
Do you have any ongoing or chronic medical conditions? *
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. *
Your answer
Emergency Contact name/relationship *
Your answer
Emergency contact phone number *
Your answer
List any and all medications that you are currently taking (prescription or non-prescription) *
Your answer
Do you currently hold a title approved by the state Miss Texas office? *
Are you currently a titleholder with a commitment under the direction of another Miss Texas or Miss Texas Teen approved recruiter? *
Were you recruited to participate by another contestant competing in this pageant? *
If answer to yes above, please list the name of the contestant that recruited you to participate.
Your answer
Do you currently hold a title with another organization that requires an obligation to fulfill? If yes, what title and organization?
Your answer
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