Required Forms - MISS ALABAMA USA and MISS ALABAMA TEEN USA

Fill Out the Forms Below (You Must Click SUBMIT After EACH Form)

Please note that all fields containing an * are required and your form will not be submitted without entering a value in those fields.
You will receive a confirmation email after each form has been submitted. If you do not receive a confirmation email then your form was not received by our office and you will need to reattempt submitting the form.

Fantasy Camper Profile MC Card Health Information Media Release

Fantasy Camper Profile

Entries are closed. No changes will be accepted.

MC Card

Entries are closed. No changes will be accepted.

Health Information & Release of Liablity

"*" indicates required fields

Name*

First Last

Age*

Pageant Weekend Emergency Contact - Name*

Pageant Weekend Emergency Contact - Phone Number*

Relationship to Fantasy Camper*

Current Medications*

Medical Conditions*

Medication Allergies (e.g. Penicillin)*

Mother's Name*

Please list your mother's first and last name. Should you choose not to list anyone, please enter "None" in the field above. If your mother is deceased, please enter "Deceased."

Mom's Cell Phone*

If you did not enter your mother's name in that field, please enter "000-000-0000" in this field.

Father's Name*

Please list your father's first and last name. Should you choose not to list anyone, please enter "None" in the field above. If your father is deceased, please enter "Deceased."

Father's Cell Phone*

If you did not enter your father's name in that field, please enter "000-000-0000" in this field.

Release

In consideration of participating in the Miss USA State Pageant Fantasy Camp and it's related events and activities, I agree that:
1. There are inherent risks of injury.
2. I knowingly assume those risks and agree to indemnify and hold harmless, the Miss USA Organization, the Miss Universe Organization or the sponsoring state directors, Paula Miles, Ryan Miles, and RPM Productions, Inc. for all injuries sustained, except those caused by the sponsoring director’s sole negligence.

Release of Liability

I, the parent or legal guardian of above named camper, have read this release of liability and assumption of risk agreement, I fully understand its terms and sign it voluntarily.

Parent/Guardian Signature*

Parent/Guardian - Date Signed*

Email*

Enter Email Confirm Email

Your email address will only be used to send you a confirmation of your submission.