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 *

Miss Heart of Texas (At least 18 and less than 28 by December 31, 2020)

Miss Heart of Texas Teen (At least 14 and less than 19 by December 31, 2020)

Name *

Your answer

Age *

Your answer

Birthdate *

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 *

Yes

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? *

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. *

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? *

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.

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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