Required Forms - MISS MASSACHUSETTS USA and MISS MASSACHUSETTS TEEN USA

All Forms Must Be Submitted By January 1, 2024

Please note that all fields containing an * are required and your form will not be submitted without entering a value in those fields.
You will receive a confirmation email after you click submit after the last form. If you do not receive a confirmation email then your forms were not received by our office and you will need to reattempt submitting the forms.

"*" indicates required fields

Acknowledgements*

Please note the following forms are one continuous submission and will need to be completed in its entirety. If any changes are to be made once you have submitted this form, you will need to re-submit completely.

If you are under 18, make sure you have a Parent/Guardian with you when you fill out these forms. Signature fields will be required.

I've read the above statement and I'm ready to proceed.

Name & Age Division

Name*

Please enter the name you wish to be called on stage.

First Last

Age Division*

Title*

Commentary Form

School*

Enter the high school or college you are attending, will attend, or have attended.

Year*

Major

For College Students/Graduates Only

Job Title*

Full-Time and Part-Time jobs may be listed. If you are in school, enter "Student."

Ambition*

Please limit to ONE complete sentence.

Interests

List your top THREE hobbies and talents. Remember, this is your chance to show what is unique about you!

Interest or Hobby*

Interest 1 of 3

Interest or Hobby*

Interest 2 of 3

Interest or Hobby*

Interest 3 of 3

Light-Hearted Facts

List THREE completely different facts about you for our MC to read while you are on stage. Keep the topics light (ie. The Best/Worst family vacation, most prized possession, something funny that happened at school). Write things that you would feel comfortable discussing on stage to showcase your skills and personality.

Lighted-hearted fact about yourself you would feel comfortable discussing on stage*

Fact 1 of 3

Lighted-hearted fact about yourself you would feel comfortable discussing on stage*

Fact 2 of 3

Lighted-hearted fact about yourself you would feel comfortable discussing on stage*

Fact 3 of 3

Teach One Thing

If you had to teach someone one thing, what would you teach them? (i.e. A card trick, How to play golf, How to save money, etc.) Make it unique!

If you could teach someone one thing, what would it be?*

Delegate Profile

The Delegate Profile is one of the most important forms you will complete. This is the form the Judges will read to learn more about you before the competition begins. The answers you provide to the judges will give them their first look into who you are.

These questions are important. Remember, this is your chance to reveal to the judges the most exciting facts and information about you. Don't be just another pageant girl. Be yourself, be unique, and leave them wanting to learn more about you when they meet you during the interview portion of the competition.

List three (3) things you are interested in.

Interest (1 of 3)*

Interest (2 of 3)*

Interest (3 of 3)*

What is one personal goal you would like to achieve this year?*

What quality do you like most about yourself and why?*

Why did you enter the pageant? What do you hope to gain from the experience?*

What topic are you an expert on, and why?*

Who or what inspires you, and why?*

Tell me something that will make me remember you.*

If money and skill were no object, what would be your ideal career?*

Describe yourself in one word.*

Favorite Book*

Favorite Movie*

Favorite Actor*

Favorite Song*

Favorite Sport*

Eligibility Requirements

Address*

Street Address Address Line 2 City State ZIP Code

Home Phone*

Cell Phone

Work Phone

By executing this letter in the space provided below, I hereby acknowledge and agree that I understand and have fully complied with all eligibility requirements for participation in the Miss USA/MISS TEEN USA Pageant as set forth in my State Pageant which is a preliminary to the MISS USA/MISS TEEN USA Pageant including, but not limited to, the residency requirements. Furthermore, I hereby agree that if my eligibility is questioned for any reason and a request is made by you and or IMG Universe, LLC to furnish documentation verifying my eligibility, I shall be ready, willing and able to furnish supporting documentation (e.g. birth certificate; driver’s license; voter’s registration card; income tax returns; current credit card, magazine subscription, telephone, electric, medical bills, rent receipts or other current invoices verifying my place of residence; automobile registration, verification from college or business, etc.) Establishing proof of my permanent and primary residence during the period at issue. If requested, I shall also agree to sign an Affidavit attesting to such verification of eligibility under oath. I further acknowledge and agree that the decision of any State Director and or IMG Universe, LLC, as to my eligibility to participate in my State Pageant shall be final and binding.

Signature*

Witness Name*

First Last

Witness Signature*

Parental Consent Form

Parent/Guardian Name

If Delegate is Under 18

First Last

Relationship To Delegate

As part of the consideration including the Miss Massachusetts USA/ Miss Massachusetts Teen USA Pageant to allow DELEGATE to appear in the State Pageant, the undersigned hereby represent(s), warrants, and agrees as follows:

The undersigned is (are) the RELATIONSHIP STATED ABOVE of Delegate.
The undersigned hereby consent(s) and agree(s) to the execution by Delegate of the foregoing release and to the appearance of Delegate in the State Pageant and if asked, in the MISS USA/MISS TEEN USA Pageant.
The undersigned will do any and all things necessary and reasonably required by the State Pageant or IMG Universe, LLC to assist in the full and complete cooperation of Delegate in the connection with the State Pageant and the MISS USA/MISS TEEN USA Pageant.
The undersigned hereby guarantee(s) to the State Pageant and to IMG Universe, LLC the full and complete performance by Delegate of each and all Delegate’s obligations as set forth in the Release and further guarantee(s) that the Delegate will not at any time disaffirm the Release by reason of her minority or otherwise.
If this instrument be executed by two or more persons, then this agreement shall be binding jointly and severally upon said persons and each of them, and each and all the representations, warranties, and obligations on the part of the undersigned here in above set forth shall be and are deemed to be the joint and several representations, warranties, agreement and obligations of said persons and each of them.

Delegate Signature

Parent/Guardian Signature

If Delegate Is Under 18

Sponsor Names For Program Book

Please list up to 15 sponsors who you would like to acknowledge in this year's Program Book. If you need to make changes or amendments, please recreate another form in its entirety.

List*

To add additional sponsors, press the (+) at the end of this row. Maximum of 10.

Sponsor List Tips

To add more sponsors, press the (+) icon to the right of the List box.
Please enter either the sponsor's personal name OR business name, do not enter both. (Example: Susie Smith or Joe's Automotive will be accepted. Susie Smith, Vice President of Joe's Automotive will not be accepted.)
Do not list the city of the business. (Example: Susie Smith's of Boston or Joe's Automotive in Boston, MA will not be accepted. Susie Smith or Joe's Automotive will be accepted.
Please keep the listing of first names to a minimum. (Example: Tom, John, James, Elizabeth, Mark, Kate, Adrian, Peyton, Colin, Heidi) Those could be written as "My Best Friends" or "My Co-Workers" or "My Work Family" or "The Jones Extended Family."
Consider using "Family & Friends" instead of every relative that helped you financially. (Example: Mom, Dad, Brother, Sisiter, Aunt Sue, Uncle John, My First Cousin Selena, My Great Grandmother Myrtle, My Other Aunt Sue, My Most Favorite Cutest Niece Sophie 😉 & My Dog Pookie...awww I love you Pookie!)

Medical Certificate & Release Form

Emergency Contact Person*

First Last

Relationship*

Emergency Contact Phone*

Insurance Company*

Policy Number*

Current Physician*

Physician Phone*

Health Restrictions*

I hereby attest to the fact that I am presently in good physical condition and have no known health restrictions, which would limit my active participation in the pageant.

List any ongoing medical conditions for which you are currently being treated or taking medication.*

If none, enter "None"

List any medication you are currently taking.*

If none, enter "None"

List any allergies to medications. (e.g. penicillin)*

If none, enter "None"

Do you have any of the following conditions? (check only if applicable)

Epilepsy

Asthma

Diabetes

High Blood Pressure

Other (Please Specify)

Other Medical Condition

Release of Liability

PARENTAL/CONTESTANT CONSENT FOR MEDICAL DIAGNOSIS, TREATMENT, BILLING OF INSURANCE AND RELEASE OF LIABILITY (Parent/Guardian signature needed for minors and delegates who are on their parent's Insurance)

I (we) hereby consent to allow Clemente Organization, LLC., and staff to select a hospital, clinic, or other medical facility that shall be authorized to diagnose and treat me (her) for any medical problem that may occur during my (her) stay at the state preliminary pageant. In addition, I (we) hereby give permission to those granting services to bill our Insurance Company listed for any and all services listed. I (we) agree that by participating:

1. There are inherent risks of injury.

2. I (we) knowingly assume those risks and agree to indemnify and hold harmless, IMG Universe, LLC and Clemente Organization, LLC., for all injuries sustained, except those caused by the producer’s sole negligence.

Delegate Signature

Parent/Guardian Signature

If Delegate Is Under 18

Rules & Regulations

In order to help our event run smoothly, we ask that all delegates observe a few simple rules. Thank you for your cooperation.

There will be no smoking in public. The Pageant does NOT advocate smoking and you must be considerate of your roommate.
Delegates must participate in all pageant activities and wear pageant identification at all times.
Delegates must be in the company of a Pageant Chaperone AT ALL TIMES, when not in your hotel room.
Do not venture off by yourself, you must stay with the group. You are not allowed to leave the hotel.
The pageant schedule is very busy! Delegates are required TO BE ON TIME!
The pageant will provide lunch and dinner on Saturday, brunch on Sunday. THERE ARE NO OTHER SCHEDULED MEALS! Bring snacks if you feel you will be hungry. Room service is CASH ONLY!
“Reread Number 6”
Any phone calls or incidental expenses will be the delegate’s responsibility. Any fees incurred will be collected Sunday during rehearsal.
No hosiery will be allowed during swimsuit competition. Leg make-up is permissible.
Security is provided, however, we cannot be responsible for valuables or for the safety of contestants not following the rules designated. Mark your clothes and other items for easy identification.
Delegates and their parents, friends, relatives, etc. are not to engage any of the judges or auditors in conversation at any time prior to the conclusion of the final event on Sunday.
Only official staff will be permitted backstage at any time during the pageant. Help will be provided by the pageant staff to assist all delegates in the dressing rooms.
There will be no consumption of alcoholic beverages or any drug, regardless of age.
NO hairdresser, makeup artists, parents or other visitors will be allowed in your hotel room or back stage. Contestants are allowed to visit in other contestant’s rooms.
No cell phones during rehearsals.
Courtesy and proper language is required at all times.

Delegate Signature*

Parent/Guardian Signature

If Delegate Is Under 18

Enter Email & Submit

Changes*

If I need to make any changes, I acknowledge that I must submit this form again in its entirety.

Email*

Enter Email Confirm Email

Your email address will only be used to send you a confirmation of your submission. This will not be included on the Delegate Profile that the judges receive.

All Forms Must Be Submitted By January 1, 2024

Name & Age Division

Commentary Form

Delegate Profile

Eligibility Requirements

Parental Consent Form

Sponsor Names For Program Book

Medical Certificate & Release Form

Rules & Regulations

Enter Email & Submit

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