Form B: Release

Form B: Release
READ VERY CAREFULLY BEFORE SIGNING
CONTESTANT’S NAME*
In consideration of participating in the Mrs. Alabama America® Competition and its 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, Mrs. America Productions, Inc., and the sponsoring State Director for all injuries sustained, except those caused by the sponsoring director’s sole negligence.

By the signature below, I represent that I have have read this release of liability and assumption of risk agreement, fully understand its terms and sign it voluntarily.
EMERGENCY INFORMATION
In the event of a medical emergency for the above named contestant on the day of the pageant, I understand that Rhonda G. Gilliam will send me by ambulance to the nearest hospital. Someone can be reached at the number below and will meet the above named contestant at the Hospital Emergency Room to arrange and be responsible for her medical expenses. I hereby release Rhonda Gilliam/

Mrs. Alabama America® Pageant Staff and Mrs. America Inc. (MAI) from all liability. By the signature below, I represent that I have

read this Emergency Information, fully understand its terms and sign it voluntarily.
Name

First NameLast Name
Date Date

MonthDayYear
Date
Contestant Signature Date*

Clear
Contestant Signature Date*

MonthDayYear
Date
Emergency Number for your State Director to contact a family member on Pageant Day
Hotel
Where are you staying?
Hotel Phone number
Hotel
What name did you use to register at that hotel?
Hotel Registration Name
Name of Husband
Husband’s Cell Phone
- Mrs. Alabama America®
FORM B
Should be Empty:

READ VERY CAREFULLY BEFORE SIGNING

EMERGENCY INFORMATION

Name of Husband

FORM B