2025 National Application

2025 National Application
Age division:*
Name*

First NameLast Name
Age*
Grade/Profession
State Title*
Please list 2-3 options in order of top choice.
Why did you enter the pageant?
Hobbies
Volunteer Work
Leadership Roles
Awards/Honors
Interesting Facts

Contestant Contact Form
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Parent/Guardian Number
Please enter a valid phone number.
Email*
example@example.com
Contestant Date of Birth*

Medical Release

You have my permission to administer emergency treatment for myself/daughter if it becomes necessary.
Contestant Name*

First NameLast Name
Parent/Guardian Name*

First NameLast Name
Allergies :
Medical Conditions:
Medications that may need to be administered:
Licensed RN is on staff.
Special Accessibility Requests:
Contestant Signature*

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Parent/Guardian Signature if under 18*

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N/A if not applicable
Todays Date

MonthDayYear
Date

Contestant Contract

2025 America’s Civic Miss Terms and Conditions
I, (Contestant), Daughter of (Parent/Guardian) have of my own will as determined by my age as of January 1, 2025, and upon being appointed my state title, I am committed to representing my community by participating in 2 appearances a month. 1 appearance must be community service related. These appearances will be posted on social media with #ROCKYourCrown and #AmericasCivicMiss I will participate in the National pageant either in person or virtually.
By initialing the following points, I acknowledge that I have read and understand my obligations and the rules of this agreement, terms and conditions as have my parent(s)/guardian if under the age of 18. (Each must initial and sign below).
RULES AND REGULATIONS:The Pageant Contestant (“Contestant”) and both Parents/Guardian (“Parent”) agree to abide by all of the rules and regulations established by America’s Civic Miss including, without limitation, those relating to enrollment, withdrawal and event overall.
Contestant Initials*

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Parent/Guardian Initials*

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N/A if not applicable.
TERMS OF PARTICIPATION: Contestant and Parent agree to the following terms of participation:

1. Contestant must be single with no children if under the age of 18 as of January 1, 2025. Contestant must have been born female, unless competing in the Mx division.

2. Contestant will be judged on the following areas: Role Model Binder, Personal Interview, Evening Gown and Self Expression. Decision of the judges will be final. Should there be a tie, the winner will be chosen with the highest role model score, then interview, then by the Head Judges discretion.

3. If for any reason a contestant is declared a winner, and later disqualified, the next choice of the judges will be declared winner. The disqualified contestant agrees to forfeit all prizes to the new announced winner. Prizes are to be returned or paid back in full. No refunds are honored in above circumstances on any fees at any time.

4. If Contestant is named a National winner, Contestant and Parent agrees to participate in the 2026 National Event in order to receive their full prize package. National winner is expected to participate in 3 appearances a month, 1 being community service related. National winner is a non-compete position. Fun pageants may be done at discretion of the director, failure to do so will result in disqualification.

5. Contestant and Parent will not discriminate with regard to sex, gender, sexual orientation, ethnic group identification, race, ancestry, national origin, religion, color, physical disability, age, marital or parental status while being a titleholder. This includes any social media platforms. This is grounds for disqualification.

6. Contestant will promote the ROCK Your Crown (Raising Outstanding Confident Kind Women) Program by teaching others the importance of being the best versions of ourselves, the importance of being kind and the importance of being a valued member of our communities.

7. Bad sportsmanship/Bullying will not be tolerated! Anyone having participated in any bullying or bad sportsmanship in person or on social media while being a contestant will have 5 points deducted from their score! Moms this includes you! If this behavior is seen by our pageant staff at the pageant you will be disqualified. No entry fee will be returned. This pageant is supposed to be fun and we are to empower one another.

8. Contestant agrees to abide by all America’s Civic Miss Rules, Terms, Conditions and Codes of Conduct and respect all America’s Civic Miss employees, and sponsors/vendors.

9. Communication is important. At times Directors and staff may become busy. It is your responsibility to check in with your Regional Director or National Director should you have questions/concerns. If you have medical emergencies that prevent you from completing your appearances, this as well should be brought to our attention within 30 days of the medical emergency. We will work with you, but only if we are aware. Failure to communicate could lead to disqualification.
Contestant Initials*

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Parent/Guardian Initials*

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N/A if not applicable.
IMAGES, VIDEOGRAPHY, WEBSITE, SOCIAL MEDIA, PROGRAM BOOK, ETC: Permission is hereby given for America’s Civic Miss and ROCK Your Crown to use in promoting America’s Civic Miss and in other ventures directly relating to America’s Civic Miss or ROCK Your Crown digital, photographic, video and audio images or likenesses of Contestant; and statements, articles, names, music, art, photographs, audio recordings, films and videos created by Contestant or originating from America’s Civic Miss or from an America’s Civic Miss-related activity.
Contestant Initials*

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Parent/Guardian Initials*

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N/A if not applicable.
LIABILITY: In consideration of permission for Contestant to participate in America’s Civic Miss, I, on behalf of myself, my child, my spouse, my personal representatives, do hereby, waive, and discharge America’s Civic Miss and the ROCK Your Crown Program including its contractors, sponsors, employees and directors from liability from all and any claims resulting from the inherent risks of pageant activity and cost.
Contestant Initials*

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Parent/Guardian Initials*

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PAYMENT/PAYMENT PLANS: America’s Civic Miss is happy to set up a payment plan for fees. Please contact our office to request a plan. Payments must be received in full by July 1st, 2025, failure to do so will result in a $25 late fee. Failure to be recieved by July 31st will result in in disqualification.
Contestant Initials*

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Parent/Guardian Initials*

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REFUNDS: Contestant and Parent understand that all fees paid to America’s Civic Miss or ROCK Your Crown are not refundable and not transferable in full or in part under any circumstances. This includes, but is not limited to entry fees, pageant admission tickets, ad pages and any other fees paid to Americas’s Civic Miss or ROCK Your Crown by anyone including but not limited to Contestant, Parent, or Sponsors.

No refunds are given at any time, including should Parent or Contestant need to cancel for any reason (including personal choice). Contestants will be offered to compete in the following year.
Contestant Initials*

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Parent/Guardian Initials*

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N/A if not applicable.
By signing below, I understand that all contestants and their parents/guardians further covenant and agree not to sue the Americas Civic Miss, ROCK Your Crown, its directors individually, its employees, volunteers, staff, sponsors or vendors for any claim for damages or liability. I agree to abide by all of the rules and regulations set forth by the America’s Civic Miss pageant.
Contestant Signature *

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Parent/Guardian Signature*

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N/A if not applicable.

Payment/T-Shirt
T-SHIRT

Required of all contestants.

Please choose your shirt size indicate any additional shirts you may want.

Youth: xs ___, s____, m____, l____,

Adult: xs____, s____, m____, l____, xl____, 2xl____, 3xl____

$100 due upon contract signing to receive at large crown and sash. Remaining entrance fees are due July 1st ($300 for at large, $100 for state at large contestants and $100 for state winners).

PAYPAL please choose sending to friends/family ID: americascivicmiss@gmail.com

Venmo: @MeganCormier1
Should be Empty:

2025 National Application

Contestant Contact Form

Medical Release

Contestant Contract

Payment/T-Shirt