Miss Gulf Coast USA Pageant 2021
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Email address
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Your email
Crowning of Miss Texas USA 2020
Crowning of Miss Texas Teen USA 2020
Division
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Miss Gulf Coast- ALL BIRTHDATES DURING 1993-2002
Miss Gulf Coast Teen- ALL BIRTHDATES DURING 2002-2006
Name
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Your answer
Age
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Your answer
Birthdate
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MM
/
DD
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YYYY
Cell Phone
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Your answer
Permanent Address (include city, state, zip)
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Your answer
Mailing Address if different (include city, state, zip)
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Your answer
School/College
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Your answer
Grade/Year
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Your answer
Are you a previous contestant
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Yes
No
Mom/Guardian Name (if a minor)
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Your answer
Mom/Guardian Email (if a minor)
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Your answer
Mom/Guardian Cell (if a minor)
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Your answer
Dad/Guardian Name (if a minor)
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Your answer
Dad/Guardian Email (if a minor)
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Your answer
Are you allergic to any medications or foods?
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Yes
No
please list if yes
Do you have any ongoing or chronic medical conditions?
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Yes
No
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?
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Choose
Yes
No
please explain if yes
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.
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Your answer
Emergency Contact name/relationship
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Your answer
Emergency contact phone number
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Your answer
List any and all medications that you are currently taking (prescription or non-prescription)
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Your answer
Do you currently hold a title approved by the state Miss Texas office?
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Yes
No
Are you currently a titleholder with a commitment under the direction of another Miss Texas or Miss Texas Teen approved recruiter?
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Yes
No
Were you recruited to participate by another contestant competing in this pageant?
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Yes
No
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?
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