| DIVISION: (Check One) ** Please
Note: New Age Divisions |
 Miss Dance |
Teen Miss
|
Junior Miss
|
Petite Miss
|
| Mr. Dance |
Teen Mr.
|
Junior Mr.
|
Master |
| ENTRANT'S PERSONAL INFORMATION: |
| Name of Entrant: |
___________________________________________________ |
| Name of Parent or Legal Guardian: |
___________________________________________________ |
| Mailing Address: |
___________________________________________________ |
| City / State / Zip Code: |
___________________________________________________ |
| Home Telephone: |
_(______)______________________ |
| Entrant's Age: |
____________ Birthdate (mm/dd/yy): ___________________ |
| MEMBER TEACHER INFORMATION: |
| Teacher of Record: |
___________________________________________________ |
| Teacher of Recognition: |
___________________________________________________ |
| Studio Name: |
___________________________________________________ |
| Studio Address: |
___________________________________________________ |
| City / State / Zip Code: |
___________________________________________________ |
| Home Telephone: |
_(______)______________________ |
| Studio Telephone: |
_(______)______________________ |
VIDEO ORDER FORM:
All Solo Title Videos will be sold through the treasure's office. Each
tape will contain footage of the OPENING ROUTINE, YOUR ROUTINE, and THE
AWARDS CEREMONY. See Video Order Form.
| MEDICAL AUTHORIZATION FORM:
(COMPLETED BY ALL ENTRANTS UNDER THE AGE OF 18)
I hereby certify that I, _________________________________________,
am the parent and natural guardian of ______________________________,
a minor under the age of eighteen (18) years of age. I hereby authorize
the Dance Masters of California, Inc. , Chapter 13, their agents,
or employees to obtain whatever medical and/or hospital care and
treatment that may be deemed necessary, within their sole discretion,
while my minor child is attending the Dance Masters of California,
Inc. , Chapter 13 All Solo Title Pageant rehearsals at the Jensen
Performing Arts Center in Milpitas and rehearsals and performances
held at the Santa Clara Convention Center and The Hyatt Hotel Santa
Clara, for the duration of the time frame laid out within the rules
and rehearsal schedules.
| ________________________________________ |
_______________________ |
| Signature of Parent/Legal Guardian |
Date |
MEDICAL AUTHORIZATION FORM:
(COMPLETED BY ALL ENTRANTS OVER THE AGE OF 18)
I hereby certify that I, _________________________________________,
hereby authorize the Dance Masters of California, Inc. , Chapter
13, their agents, or employees to obtain whatever medical and/or
hospital care and treatment that may be deemed necessary, within
their sole discretion, while I am attending the Dance Masters of
California, Inc. , Chapter 13 All Solo Title Pageant rehearsals
at the Jensen Performing Arts Center in Milpitas and rehearsals
and performances held at the Santa Clara Convention Center and The
Hyatt Hotel, Santa Clara, for the duration of the time frame laid
out within the rules and rehearsal schedules.
| ________________________________________ |
_______________________ |
| Signature of Entrant |
Date |
|
RELEASE FORM:
I hereby acknowledge that I have read the official rules and regulations
of the 2009 Dance Masters of California, Chapter 13 All Solo Title Pageant
for which I am entering and, that I am complying with the rules. The personal
data herein set forth is correct.
I give my permission as an entrant to be video taped during the 2009
All Solo Title Pageant. It is my understanding that these video tapes
will be used solely for Dance Masters of California, Inc. Chapter 13 at
their discretion and in a manner benefiting the high standards of the
association. It is further my understanding that these video tapes may
be offered for sale at the discretion of Dance Masters of California,
Inc. Chapter 13.
In consideration of being accepted as an entrant in the 2009 All Solo
Title Pageant, we do hereby release the director of the competition, her
assistants, Dance Masters of California, Inc. Chapter 13, the Hyatt Hotel,
the Santa Clara Convention Center, Jensen Performing Arts Center and the
facilities which the competition is presented, from any and all claims
for damages or for injuries which the entrant might sustain while participating
in any activity connected with this competition.
Failure to obtain the below three signatures prior to the entry deadline
will disqualify applicant from entry in the 2009 All Solo Title Pageant.
| _________________________________ |
|
_________________________________ |
| Signature of Entrant |
|
Signature of Entrant's Parent/Legal Guardian |
| _________________________________ |
|
|
| Signature of Teacher of Record |
|
|
SOLO TITLE AGREEMENT
(MUST BE SIGNED BY ALL PARTIES):
WE THE UNDERSIGNED, DO HEREBY AGREE, WITHOUT EXCEPTION, TO THE FOLLOWING:
1. That the information presented is true.
2. That the rules and regulations have been read by the sponsor teacher,
the entrant, and the entrant’s parents and that all rules and regulations
as stated or announced thereafter shall be adhered to.
3. That the rehearsals and meetings as stated or announced thereafter
shall be attended promptly without exception.
4. That the entrant will be properly dressed and groomed at all times.
5. That the entrant is of good moral character, not using foul language
or engaging in any activity that is not upholding the standards of Dance
Masters of California, Inc. Chapter 13.
6. That if I am the winner of this years Solo Title Competition, I, my
parent, and sponsor teacher shall and will sign required agreement governing
my reign.
| _________________________________ |
|
_________________________________ |
| Signature of Entrant |
|
Signature of Entrant's Parent/Legal Guardian |
| _________________________________ |
|
|
| Signature of Teacher of Record |
|
|
|
