MISS B: Release

Form B: Release
READ VERY CAREFULLY BEFORE SIGNING
CONTESTANT’S NAME
In consideration of participating in the Miss Alabama for America Strong® Competition and its related events and activities, I agree

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/

Miss Alabama for America Strong® Pageant Staff and the Miss for America Strong Pageant from all liability. By the signature below, I

represent that I have read this Emergency Information, fully understand its terms and sign it voluntarily.
Contestant Name
Date

MonthDayYear
Date
Contestant Signature

Clear
Signature Date

MonthDayYear
Date
Emergency Number for your State Director to contact a family member on Pageant Day
Hotel Name
Hotel Phone number
Format: (000) 000-0000.
Hotel Registration Name
What name is the room registered in?
Family Name
Family Member Cell Phone
Format: (000) 000-0000.
Should be Empty:

Form B: Release

READ VERY CAREFULLY BEFORE SIGNING

EMERGENCY INFORMATION