Miss Southwest Outstanding Teen Contestant Cover Letter
(Accompanies all paperwork)
Name ______________________________________________________
E-mail address _______________________________________________
Phone Numbers ___________________ Home __________________Cell
Home Address _______________________________________________
________________________________________________
Mailing Address
(If different from above)
_______________________________________________
_______________________________________________
2012 LOCAL CONTESTANT
Manually Fillable Local Contestant Contract (one per
contestant)
Click here to download
Computer Fillable Local Contestant Contract (one per
contestant)
Click here to download
(Waiting for the correct links from the Miss Teen Organizers. These are the links I
copied from the Miss Michigan site – can we link these contracts to the teen page like
this or do the contestants have to first go to the Miss Michigan Teen site?)
Name: Jane Doe
Hometown: Anytown, Michigan
Date of Birth: December 29, 1995
Education: Currently a sophomore at Anywhere High School, Anywhere, Michigan
Scholastic/Career Ambition: Attend University of Michigan/Veterinarian
Talent: Interpretive Dance
Scholastic Honors: Recipient of National Coca-Cola Scholarship; Honor Roll; Math &
Science Olympiad Award Winner
Leadership Roles: Organized a fundraiserCreated and implemented a comprehensive
Cultural Diversity Education Curriculum for grades 9th and 10th Grade Student Council,
4H Club President
Accomplishments: Recipient of the J.C. Penney Golden Rule Award for Outstanding
Volunteer Service to
Community; Performed at Kalamazoo Civic Theater; Completed two (2) ½ marathons
Interesting Facts: Oldest of four children and a twin, parents are each twins as well.
Passion for reading and Art
Employment (if any): Babysitting, lawn work and helping mom in retail store
Why I should be Miss Southwest Michigan Outstanding Teen this year: I believe I
would be a good roll model not only for my peers but for younger children. I make every
effort to live my life with integrity and honor and embrace the opportunity to share my
values and good judgment with others. I am committed to whatever project I become
involved with and would welcome the chance to represent Southwest Michigan.
1
Miss Southwest Michigan’s Outstanding Teen Production
Questionnaire
Title:
________________________________________________________________________
Name:
________________________________________________________________________
Talent (Song, Dance, etc.): _________________________________________________
Title of Performance:
________________________________________________________________________
Accompaniment (Check one :) CD _______ None: ______ Other: _____
Please TYPE exactly how you want your talent introduced:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
All talent presentations may be 90 seconds in length (must not exceed 90 seconds)
All accompaniment music must be on CD, unless it is live.
Please state the exact time of your talent: ________________
Complete listing of props needed for talent (only functional props will be allowed, that is,
props that are actually used in your act).
________________________________________________________________________
________________________________________________________________________
If your talent will be dramatic reading, comedy monologue, etc., give the name of the
book, play, or writing you will use:
Name of Book, play, or writing:
________________________________________________________________________
Author:
___________________________________Publisher:____________________________
I will bring the following props which I will use in my talent presentation:
________________________________________________________________________
***Please note:
In the case of two contestants requesting the same talent music, the contestant that first
registers her talent music with us will have priority. Talent music will not be duplicated.
CONTESTANT RELEASE AND INDEMNITY AGREEMENT
I, ________________________________________ a contestant in the 2012 MISS
SOUTHWEST MICHIGAN OUTSTANDING TEEN PAGEANT do hereby knowingly and
voluntarily release the Miss Southwest Michigan Scholarship Pageant Organization, their
Officers, Directors, Trustees, Judges and Employees and any others person, firm, individual or
corporation charged or chargeable with responsibility or liability, their heirs, administrators,
executors, successors and assigns from and against any and all claims, lawsuits, demands,
damages, loss of service, actions and causes of action based upon, arising out of, or in any way
related to any honors, rights, or awards sought by me as a contestant in the 2012 MISS
SOUTHWEST MICHIGAN OUTSTANDING TEEN PAGEANT, the conduct of
business thereat, the ownership and possession of any honors, rights, or awards thereby, any
negligent act, act of misfeasance or nonfeasance by the referenced pageant, or any of their agents,
contractors, servants, employees or licensees, in conjunction with any honors or awards bestowed
at said listed above from any and all claims that exonerate, hold harmless and indemnify such
pageant listed above from any and all claims that I or my representative may have against such
honors, rights and awards. Such indemnification to include any or all fees (including reasonable
attorney’s fees), costs and other expenses reasonably incurred by or on behalf of the above
actions or causes of action. I have had a full and adequate opportunity to be thoroughly advised of
the terms and conditions of this release and indemnity agreement by counsel of my own choosing.
I have also been afforded the opportunity to ask any and all questions that I have concerning this
document and its execution by me. I do fully understand if selected MISS SOUTHWEST
MICHIGAN OUTSTANDING TEEN, I will agree to enter into a Management Contract. I
do fully understand the terms of this agreement and do intentionally and voluntarily agree to
same.
______________________________________
Signature (Contestant)
___________________________________________________________________________
Signature(s) (Parent[s]/Guardian[s] of Contestant)
STATE OF_________________
COUNTY OF ______________
Sworn To, Subscribed and Acknowledged before me on _______day of _______, 20_____,
by
___________________________________________who is/are personally known to me or
who has/have produced valid identification. Personally Known _______ OR Produced
Identification _______ Type of Identification Produced
________________________________________________
_______________________________
NOTARY PUBLIC
(SEAL)
_______________________________
Notary Print Name
My Commission Expires __________