Idaho Miss Dance Drill Registration Form

Idaho Miss Dance Drill Registration Form

November 10, 2018

Please check which applies to you:Miss Dance Drill ______Teen Miss Drill ______

Contestant’s Full Name ______Current Age (as of Jan 1st): ___Birth Date: ______

Contestant Email: ______Cell: ______

Contestant Mailing Address: ______City/State: ______Zip ______

______/ ______/ ______
Print Parent’s name (or guardian) / Parent’s signature (or guardian) / Date
Parent Email: ______Cell: ______
______/ ______/ ______
Print Coach’s Name / Coach’s Signature / School

Coach’s Email: ______Coach’s Cell: ______

School Classification: 1A – 2A – 3A – 4A – 5A (please circle)

Waiver of Liability: I hereby waive and absolve Idaho Miss Dance Drill Team and all divisions thereof of any and all liability and responsibility for injuries, sickness, accidents, and/or acts of God incurred during participation in competitions and related activities (including nationals – MDDTUSA event) by myself/my child,

whose name is:
______/ ______/ ______
Participant’s name (please print) / Parent/Guardian’s name (please print) / Parent’s Cell #

In consideration of participant’s and parent/guardian’s accepted release of liability allows my child/myself to participate in a IMDDT activity, I, intending to be legally bound, do hereby, my heirs, executor and administration, waive, release, and forever discharge any and all rights and claims for damage which I may have or which may hereafter accrue to me against IMDDT, the camp/clinic/competition/pageant directors or their respective employees, office agents, representatives, successors, and/or assignee, for any and all damages which may be sustained or suffered by me or my child in connection with my association with or participation in, or riding out of travel to and/or return from the respective IMDDT or Miss Drill USA site. In the event of injury/accident/sickness, IMDDT officials and/or instructors are to contact the designated adult listed above. In addition, I hereby give my permission for myself/my child to be photographed, videotaped, and/or audio-taped during any IMDDT and Miss Drill USA activity. I further give permission for such photographs, videotapes/DVD’s, and/or audio-tapes to be used in print or broadcast media as deemed appropriate for promotion of IMDDT activities, and for publicity surrounding participation in IMDDT events.

Accept ______Decline______

______

Participant’s SignatureParent’s Signature

Registration Fee $85 - Deadline is Oct. 26th- $20 late fee after Oct. 26th

NO REFUNDS, only credit toward upcoming year’s competition/event.

Check # ______Make checks payable to: IMDDTmemo: Miss Drill Team Idaho, Teen Miss Drill Or Junior

Please check: VISA – MasterCard – Discover – American Express CC# ______

Name on card: ______Exp. Date ______Security code ______

*Please be aware that there will be 3% processing fee added to all CC payments.

If you prefer to mail your registration in with payment, please send to: IMDDT - Attn. 273 E Rio Colinas Meridian ID 83646

**Make all checks payable to: IMDDT