Online Registration

Please complete the following application to apply for any of Duval's pageants. 

*Highlighted purple text must be completed in full or if left blank, would forfeit your placement as a contestant in the pageant.  

*Stage Name                   

 

*Given Name                   

 

*Address                         

 

*City         *State         *Zip Code   

 

*Phone #   

 

Alternate # 

 

*Email Address 

 

*How do you want to be contacted?   

 

*Pageant registering for

 

Sponsor (s)

 

Type of Talent

 

Dancers  Yes    No

Props      Yes    No

 

The rules and regulations of the pageant and hereby covenant to abide by the same by electronically signing my signature below.  I agree to release, hold harmless, to the above Duval pageant I am registering for, hereafter referred to as the "PAGEANT," their agents, servants and employees, from any liabilities an/or responsibilities whatsoever resulting from, associated with or arising out of my participation in the pageant, or/ or the title I have registered for above, but not limited to personal injury, or loss or damage to my personal property, regardless of whether the loss or injury occurs before, during or after the pageant or any other related activities.

 

I also hereby release, myself from rights to any videotaping (sound and/or video), photography, recording, still camera or motion pictures of the pageant.  I understand that I have no rights to any of the recording that I appear in/on, or the future sales thereof.

 

I hereby agree that my name or any photographs taken of me during the pageant, may be used for publication for promotional purposes or in advertising publicity.

 

By electronically signing below, I affirm and attest that I have read and agree to the above terms of this application.  I understand that this application is held in the strictest of confidence, to be utilized and analyzed only by the Duval Pageantry System staff, agencies and entities, and will not be sold, suggested or transferred to third parties, unless otherwise notified.

 

*APPLICATION NOT VALID WITHOUT TYPING YOUR NAME AND DATE IN THE BOX BELOW, WHICH ACTS AS A FORMAL ACCEPTANCE OF APPLICATION.

 

Type your given name here   

                                                             (ex. John Doe)

 

Type date here (mm/dd/yyyy)        

                                                             (ex. 07/31/2009)