OFFICIAL ENTRY FORM & AFFIDAVIT – Houston USA Pageant

Official Contestant Entry Form and Affidavit

Apply here to become a contestant in the Miss Houston or Miss Houston Teen competition.

"*" indicates required fields

Which Competition Are You Applying For?*

If you were born in 2007 you can compete in either division.

Miss Houston USA (Born 2007 or before)

Miss Houston Teen USA (Born during 2007-2011)

Name*

First Middle Last

Address*

Street Address Address Line 2 City State ZIP Code

County*

Austin, Brazoria, Brazos, Chambers, Colorado, Fort Bend, Galveston, Harris, Lavaca, Liberty, Matagorda, Montgomery, San Jacinto, Walker, Waller and Wharton.

Cell Phone Number*

Email*

Enter Email Confirm Email

Date of Birth*

Occupation

(if applicable)

Employer

Business Phone

Education

School/College

City

State

Grade/Year/Year Graduated

Degree(s)

If a college graduate

Parent/Guardian's Contact Information

If you're under the age of 18, please fill out your parent/guardian's contact information.

Parent/Guardian's Name

First Last

Parent/Guardian's Cell Phone

Parent/Guardian's Email

Enter Email Confirm Email

Tell Us About Yourself

Awards & Honors

Hobbies & Interests*

Ambition*

Reason for entering*

How did you hear about this pageant?*

Eligibility Requirements

Please read all of the eligibility requirements.*

• (TEEN) I have never been married nor had a marriage annulled. I have never given birth to a child, I am not a parent, and I am not currently pregnant.
• I am a female by birth or recognized medically and legally.
• I am, a citizen of the United States and will remain a citizen of the United States through the pageant.
• I live and/or attend school in one of the following counties in Texas: You must live or attend school in one of the following counties to qualify to be a contestant: Austin, Brazoria, Brazos, Chambers, Colorado, Fort Bend, Galveston, Harris, Lavaca, Liberty, Matagorda, Montgomery, San Jacinto, Walker, Waller and Wharton.
• If I am the current titleholder in any local, state, or national pageant or competition system, I acknowledge and agree that, unless I receive permission from Diverse Dreams LLC, I must resign that title immediately to compete in the Houston USA pageant.
• I agree that if I participate in the Houston USA pageant, I will abide by all the rules and regulations governing the pageant.
• Neither I nor any member of my immediate family (i.e., mother, father, sister, or brother) or anyone living in my household is currently or has within the last two (2) years been, employed by or an officer, director, or agent (including a volunteer worker) of Diverse Dreams LLC.
• I am not currently a candidate for public office.
• I am not a member of a performing arts union or guild.
• I understand that I must pay the entry fee of $695.00 and purchase at least one (1) full page, color ad ($100.00) for the digital pageant program magazine.
• I represent that at all times prior to the date of this Agreement, I have conducted my activities and life in accordance with the highest ethical and moral standards and that I have never been charged with the commission of a crime or engaged in any activities that might bring myself, you, or any of your respective subsidiaries, affiliated or related companies, officers, directors, partners, shareholders or employees into public disrepute, ridicule, contempt or scandal or might otherwise reflect unfavorably upon any of the foregoing individuals or entities or might shock, insult or offend the community or any class or group thereof.
• I acknowledge that, by way of example, and without limiting the generality of the foregoing in any way, having appeared in public or permitted myself to be photographed in a state of partial or total nudity or in a lewd, compromising or sexually suggestive manner constitutes a violation of this agreement.
• I hereby release, unconditionally and forever, any claim against the Houston USA pageant, Miss Houston USA pageant, Miss Houston Teen USA pageant, Diverse Dreams LLC, their parent of affiliated or related companies and their respective officers, directors, partners, employees, sponsors, agents and assigns, which I may have by virtue of my participation in the pageant(s) or by any use of my name, likeness, voice and/or biography in connection with the pageant(s), including use in promotional and advertising material.
• I understand and agree that if I become a holder of any titles given by Diverse Dreams LLC that I will sign and abide by the titleholder’s contract given by Diverse Dreams LLC
• I understand and agree that Diverse Dreams LLC shall determine all issues as to eligibility and I agree to abide by that determination both as to myself and other applicants.
** I understand the Houston USA pageant is not contracted with the Miss Universe, Miss USA or Miss Teen USA pageants.

I agree all of the statements listed above are are true

All Fees Are Non-Refundable*

I understand that as soon as I submit this application and initial payment, Diverse Dreams LLC automatically makes the necessary plans for my participation in the pageant. Therefore, if I should drop out of the pageant, there will be no refund of the initial payment, nor for any fees paid subsequent to the initial payment. All fees paid are not transferable.

By their signatures below, applicant and her parent or guardian certify that they have read and understand the rules, regulations and eligibility requirements set forth above and that the applicant meets and will comply with the rules, regulations and eligibility requirements stated. Any untrue statement or failure to comply may result in applicant’s disqualification with no refunds of monies already paid.

Contestant Signature*

Parent/Guardian Signature

Official Contestant Entry Form and Affidavit

Education

Parent/Guardian's Contact Information

Tell Us About Yourself

Eligibility Requirements

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