Little Miss POLISHED EARL ScHOLARSHIP AGEANT THE Essence … · 2019-05-07 · 4 Little Miss...

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Little Miss POLISHED PEARL ScHOLARSHIP PAGEANT THE Essence of IvY AND PEARls FouNDATION BoARD Of DiREctoRS TiffANY West PREsiDent JennifeR HenDeRSOn Vice-PREsiDent FRANces THiBODeAUX-fox SeCRETARY AMA ADDAI TREASURER LATREse YoRK FinANciAL SeCRETARY Essie MASOn-PURNell PARLiAMenTARIAN RHeA HenDeRSOn FunDRAIsinG AND ResoURCE DeveloPMEnt CHAIRMAn CouRTNeY THOMPSOn PUBliciTY CHAIRMAn SHeenA HoGue SCHOlARSHiP CHAIRMAn MARICHA MATTHews MicHelle McClenDOn MeMBeRS-At-LARGe ContesTAnt PRe-REGISTRATIOn FORM Contestant’s Full Name: Parent / Legal Guardian’s Name(s): Address: City: State: ZIP: _ Telephone: Contestant’s Age on 9/15/2019: School & Grade on 9/15/2019: Hair Color: Eye Color: Hobbies: Honors & Awards: Extra-Curricular/Community Service: Rules & Regulations: Parents or legal guardians of prospective contestants must read the following information and sign if the official application is to be considered. Judges’ decisions are final. Poor sportsmanship will result in disqualification of contest and forfeiture of any prizes. Contestant’s parent or legal guardian must give permission to the Essence of Ivy and Pearls Foundation (EOIP), its members, operators and affiliates to use her photographs, videos, etc. for publicity purposes and future pageant material. I understand that all funds are non- refundable. EOIP, its members, operators and affiliates are in no way being held responsible for any accidents or injury that may occur before, during, or after the pageant. In consideration for being accepted as a contestant to the pageant, we the parents and/or legal guardians of the contestant do hereby release EOIP, its members, operators and affiliates. Parent &/or Legal Guardian’s Signature Date Please email questions and inquiries to [email protected]. ContesTAnt BIOGRAPHICAl FORM

Transcript of Little Miss POLISHED EARL ScHOLARSHIP AGEANT THE Essence … · 2019-05-07 · 4 Little Miss...

Page 1: Little Miss POLISHED EARL ScHOLARSHIP AGEANT THE Essence … · 2019-05-07 · 4 Little Miss POLISHED PEARL ScHOLARSHIP PAGEANT THE Essence of IvY AND PEARls FouNDATION 2019 PAGEAnt

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Little Miss POLISHED PEARL ScHOLARSHIP PAGEANT

THE Essence of IvY AND PEARls FouNDATION

BoARD Of DiREctoRS

TiffANY West

PREsiDent

JennifeR HenDeRSOn

Vice-PREsiDent

FRANces THiBODeAUX-fox

SeCRETARY

AMA ADDAI

TREASURER

LATREse YoRK

FinANciAL SeCRETARY

Essie MASOn-PURNell

PARLiAMenTARIAN

RHeA HenDeRSOn

FunDRAIsinG AND

ResoURCE DeveloPMEnt

CHAIRMAn

CouRTNeY THOMPSOn

PUBliciTY CHAIRMAn

SHeenA HoGue

SCHOlARSHiP CHAIRMAn

MARICHA MATTHews

MicHelle McClenDOn

MeMBeRS-At-LARGe

ContesTAnt PRe-REGISTRATIOn FORM

Contestant’s Full Name:

Parent / Legal Guardian’s Name(s):

Address:

City: State: ZIP: _

Telephone:

Contestant’s Age on 9/15/2019:

School & Grade on 9/15/2019:

Hair Color: Eye Color:

Hobbies:

Honors & Awards:

Extra-Curricular/Community Service:

Rules & Regulations: Parents or legal guardians of prospective contestants must read the following information and sign if the official application is to be considered. Judges’ decisions are final. Poor sportsmanship will result in disqualification of contest and forfeiture of any prizes. Contestant’s parent or legal guardian must give permission to the Essence of Ivy and Pearls Foundation (EOIP), its members, operators and affiliates to use her photographs, videos, etc. for publicity purposes and future pageant material. I understand that all funds are non-refundable. EOIP, its members, operators and affiliates are in no way being held responsible for any accidents or injury that may occur before, during, or after the pageant. In consideration for being accepted as a contestant to the pageant, we the parents and/or legal guardians of the contestant do hereby release EOIP, its members, operators and affiliates.

Parent &/or Legal Guardian’s Signature Date

Please email questions and inquiries to [email protected].

ContesTAnt BIOGRAPHICAl FORM

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Little Miss POLISHED PEARL ScHOLARSHIP PAGEANT

THE Essence of IvY AND PEARls FouNDATION

BoARD Of DiREctoRS

TiffANY West

PREsiDent

JennifeR HenDeRSOn

Vice-PREsiDent

FRANces THiBODeAUX-fox

SeCRETARY

AMA ADDAI

TREASURER

LATREse YoRK

FinANciAL SeCRETARY

Name:

Parent/Legal Guardian’s Name(s):

Address:

CITY: STATE: ZIP:

Essie MASOn-PURNell

PARLiAMenTARIAN

AGE (in years): as of September 15, 2019

RHeA HenDeRSOn

FunDRAIsinG AND

ResoURCE DeveloPMEnt

CHAIRMAn

CouRTNeY THOMPSOn

PUBliciTY CHAIRMAn

SHeenA HoGue

SCHOlARSHiP CHAIRMAn

MARICHA MATTHews

MicHelle McClenDOn

MeMBeRS-At-LARGe

SIBLINGS NAMES & AGES:

PETS:

SPORTS:

FAVORITE CLASS IN SCHOOL:

FAVORITE COLOR:

FAVORITE FOOD:

FUTURE AMBITION/ CAREER:

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Emergency Contact and Medical Information

M

F

Child’s Name Date of Birth Sex

Parent’s/Legal Guardian’s Name Home Phone

Address City, State, ZIP Code

Alternative Emergency Contacts

Primary Emergency Contact Secondary Emergency Contact

Home Phone Work Phone Home Phone Work Phone

Address Address

City, State, ZIP Code City, State, ZIP Code

Medical Information

Hospital/Clinic Preference

Physician’s Name Phone Number

Insurance Company Policy Number

Allergies/Special Health Considerations

I authorize all medical and surgical treatment, X-ray, laboratory, anesthesia, and other medical and/or hospital procedures as may be performed or prescribed by the attending physician and/or paramedics for my child and waive my right to informed consent of treatment. This waiver applies only if neither parent/guardian can be reached in the case of an emergency.

Parent’s/Guardian’s Signature Date

I give permission for my child to go on field trips. I release the Essence of Ivy Pearls Foundation (EOIP), its members,

operators and affiliates from liability in case of an accident during activities related to EOIP and Little Miss Polished Pearl Scholarship Pageant, as long as normal safety procedures were taken.

Parent’s/Guardian’s Signature Date

Witness Signature Date

Little Miss Sc

Essence of Iv ls Fou

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Little Miss POLISHED PEARL ScHOLARSHIP PAGEANT

THE Essence of IvY AND PEARls FouNDATION

BoARD Of DiREctoRS

TiffANY West

PREsiDent

JennifeR HenDeRSOn

Vice-PREsiDent

FRANces THiBODeAUX-fox

SeCRETARY

AMA ADDAI

TREASURER

LATREse YoRK

FinANciAL SeCRETARY

Essie MASOn-PURNell

PARLiAMenTARIAN

RHeA HenDeRSOn

FunDRAIsinG AND

ResoURCE DeveloPMEnt

CHAIRMAn

CouRTNeY THOMPSOn

PUBliciTY CHAIRMAn

SHeenA HoGue

SCHOlARSHiP CHAIRMAn

MARICHA MATTHews

MicHelle McClenDOn

MeMBeRS-At-LARGe

ADVERTISement AUTHorIZAtion FORM

The Essence of Ivy and Pearls Foundation (EOIP) is authorized to publish a (indicate size of ad) page advertisement in the ad book for the Little Miss Polished Pearl Scholarship Pageant sponsored by the Essence of Ivy and Pearls Foundation to be held on Sunday, September 15, 2019.

Payment Made to The Essence of Ivy and Pearls Foundation in the sum of: $ .

PAPER SIZE: 8.5 X 5.5 PLEASE SELECT ONE BY CIRCLING THE AD SIZE BELOW

OUTSIDE BACK COVER $250 INSIDE BACK COVER $250

INSIDE FRONT COVER $250

FULL PAGE $110 HALF PAGE $70 QUARTER PAGE $50

SIZE OF IMAGES 5.5”W x 8.5”H 5.5”W X 4.25” H 2.75”W X 4.25”H

Contestant Name (Please Print)

Organization/Firm Name:

Address: City: ZIP:

Telephone:

Signature: Date:

Ad Submission Instructions 1. Format: Advertisements should be sized as detailed above and properly formatted (high-

resolution .pdf or minimum 300 dpi .jpeg).

2. Submission: A digital copy of your advertisement (high-resolution .pdf or minimum 300 dpi .jpeg) must be emailed to [email protected] with {Insert Contestant Name} LMPP Ad Book in the subject line.

a. Please note that all cover page ads are approved on a first come first serve basis; fees for the ad must be submitted in full.

3. Payments: Advertisements may be purchased utilizing, cash, check, or money orders. Electric payments may be arranged with the financial secretary.

a. Checks and money orders must be made payable to The Essence of Ivy and Pearls Foundation.

b. A physical copy of your advertisement with this authorization form must be submitted alongside or prior to payment.

c. Ads can also be purchased by mailing a completed authorization form, a printed copy of the ad and a check or money order to: P.O. Box 685; Oak Lawn, Illinois 60454. Attn.: LMPP Ad Book

4. Questions: If you have any questions please contact Raquel Betton, LMPP Ad Book Liaison, at [email protected].

5. Deadline: Sunday August 11, 2019.

Amount:

Initial:

THIS SECTION IS FOR INTERNAL USE ONLY

Date Ad Received: Date Payment Received:

Payment Method (circle one): Cash Check Money Order Other

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Little Miss POLISHED PEARL ScHOLARSHIP PAGEANT

THE Essence of IvY AND PEARls FouNDATION

2019 PAGEAnt PARent conTRACT AnD RelEASe FORM

Photo Release

I hereby grant permission to take photos of my child/children to use in brochures,

website, posters, advertisements, or other promotional material. If I do not want photos of my child/children utilized for advertisement I will inform the pageant chairperson in writing of said request.

☐ I've read the above and agree.

Parent Financial Obligation

I understand that all fees and payments must be paid in full by the deadline as outlined in the parent handbook. I understand that my child will be removed from the program if all fees are not paid in full by the deadline. I understand that all fees are

NON-REFUNDABLE.

☐ I've read the above and agree.

Parent/Legal Guardian Attestation

I hereby attest that I am the parent or legal guardian for the contestant listed below. I understand that if it is found that I am not said parent or legal guardian, it will result in the child’s immediate removal from the roster. The child will be unable to participate

in any further activities including the production. ☐ I've read the above and agree.

Parent Handbook I hereby attest that I have received the parent handbook. I understand that it is my responsibility to review the handbook in its entirety as well as adhere to guidelines.

☐ I've read the above and agree.

Contestant Expectations

My child will attend all pageant events and activities ready to work. Excessive

absences can result in removal from the pageant at the discretion of the instructor and/or the pageant director. No cell phones allowed during workshops or rehearsals. Respectful behavior is required.

☐ I've read the above and agree.

Other Parent Expectations

I agree to check my email regularly for pageant updates. Email is the pageant’s primary form of communication. I will ensure that my child will attend all pageant events and activities ready to work. Excessive absences can result in removal from the pageant at the discretion of the instructor and/or the pageant chairperson.

☐ I've read the above and agree.

Event/Activity Cancellation Policy

Event or activity cancellations due to severe weather conditions or other incidents beyond the pageants control will be announced as information is provided to the instructor and/or pageant chairperson. Notification of weather cancellations will be emailed.

☐ I've read the above and agree.

Privacy Policy

The privacy and security of your information is a priority for the Essence of Ivy and Pearls Foundation. When making a purchase, the information provided is used to fulfill

that specific purchase. Email communications will be sent to all parents who provide an email address. We may share information with governmental agencies or other companies to assist in fraud prevention or investigation. The Essence of Ivy and Pearls Foundation may do so when (1) permitted or required by law; (2) trying to protect against or prevent actual or potential fraud or unauthorized transactions, or (3) investigating fraud which has already taken place.

☐ I've read the above and agree.

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Little Miss POLISHED PEARL ScHOLARSHIP PAGEANT

THE Essence of IvY AND PEARls FouNDATION

Medical Emergency

The undersigned gives permission to the Essence of Ivy and Pearls Foundation (EOIP), its members, operators and affiliates to seek medical treatment for the participant in the

event they are not able to reach a parent, guardian or emergency contact. I hereby declare any physical/mental problems, restrictions, or condition and/or declare the participant to be in good physical and mental health. I request that our doctor/physician on file with EOIP and its affiliates be called and that my child be transported to the hospital per the physician's recommendation.

☐ I've read the above and agree.

Release of Liability

As the legal parent or guardian, I release and hold harmless the Essence of Ivy and

Pearls Foundation (EOIP), its members, operators and affiliates from any and all

liability, claims, demands, and causes of action whatsoever, arising out of or related to any loss, damage, or injury, including death, that may be sustained by the participant and/or the undersigned, while in or upon the premises or any premises under the control and supervision of EOIP, its members, operators and affiliates or in route to or from any of said premises. ☐ I've read the above and agree.

Parent / Guardian Name Printed Date

Parent/Guardian Name Signed Date

Contestant Name Date of Birth