Miss Iowa's Rising Stars

2023 Miss Iowa's Rising Stars Registration Information:

* Indicates required field

Name *

First

Last

Address *

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City

State

Zip Code

Country

Phone Number *

Email *

Cell Phone Number *

Parent or Guardian Full Names *

Age as of June 1st, 2023 *

Birth date *

How did you hear about Miss Iowa's Rising Stars? (If recruited by candidate, please list their name.) *

Optional: Miss/Teen Candidate that you would like to be partnered with: *

Additional T-shirt ordering (If you would like additional Rising Stars program T-shirts, please note quantities and sizes. Additional fee of $15 per shirt should be added to fee total.) Size options: Child Small, Child Medium, Child Large, Adult Small, Adult Medium, Adult Large, Adult XL, Adult 2X *

Registration Payment Form

MISS IOWA'S RISING STARS PROGRAM FEES:
- $300
- $280 SIBLING DISCOUNT RATE (1ST RISING STAR PAID AT FULL PRICE)
- $250 RETURNING RISING STAR WITH MISS IOWA'S RISING STARS CROWN
- $60 REPLACEMENT MISS IOWA'S RISING STARS CROWN
ALL MISS IOWA'S RISING STARS PROGRAM FEES ARE NON-REFUNDABLE
MAIL CHECK TO (Note-Photo must still be emailed):

   Miss Iowa Scholarship Program
   Attn: Miss Iowa's Rising Stars
   P.O. Box 1595
   Davenport, Iowa 52809

Registration Fee: *

Additional T-shirt Fee: *

Registration Fee Total: *

Select from the following payment types: *

Check Credit (Please fill our Credit Card section.) Sponsorship (Please fill out sponsorship section of registration.) Venmo (@Lisa-Durbin-2) PayPal ([email protected])

Credit Card Number (Mastercard, Visa, Discover) *

Amount of Check: *

Security Code and Expiration Date: *

Total amount to be charged to the card: *

Cardholder's Name/Billing Address/City/State/Zip/Phone *

Electronic Signature acknowledging payment amount to be charged to credit card: *

Sponsor Form (Optional)

I agree to sponsor a Miss Iowa's Rising Star and understand the contribution is non-refundable. This sponsorship payment will entitle me or company to be listed as a Miss Iowa's Rising Star program sponsor in the Commemorative Miss Iowa Program Book.

Name of sponsoring person or business: *

Phone Number *

Email address: *

Rising Star Emergency Contact Information:

Emergency Contact: *

Family Physician Name and Phone Number *

Known Allergies: *

List of all medications and vitamins/supplements child is currently taking: *

Physical issues/problems that could cause your child discomfort: *

List of people your child can be released to and what is their relationship to the child: *

Photography Release:

Permission to Use Copyright Negative of Print and Website Release. As photographer and copyright owner of attached negative(s) or print(s), I grant permission for my negative or print to be used in connection with the Miss Iowa, Miss Iowa's/Miss Iowa's Outstanding Teen and/or Miss Iowa's Rising Star Program and any commercial activity emanating therefrom as well as for the purpose of producing photo cards, invitation, announcements or miscellaneous social or commercial stationary items as selected by one or more of the principals in the photographs. The negative or print cannot be used for any purpose other than listed above except for publicity or Miss Iowa Program and its affiliates and printing by a commercial printing firm in the Miss Iowa Program Book. I also grant permission for the use of these photographs on the Miss Iowa websites and/or Miss Iowa Program affiliated social media sites. I understand and agree that all such permitted uses here under shall be without compensation to me for the same. This agreement shall be binding, valid and enforceable against and the benefits thereof shall insure to, the parties' successors, licensees, assigns and parties in the privacies with them.

Photographer Name/Business Name: *

Business Address *

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City

State

Zip Code

Country

Photographer Phone Number *

Electronic Signature that all photography information is accurate: *

Statement of Understanding:

As parents or legal guardian of ______________________________, we submit her application for approval. We agree to conduct ourselves at all times in a professional manner. We will ensure that our child will conduct his/herself in a proper manner at all times and will be prompt to all Miss Iowa's Rising Star activities. We understand that this is NOT a competition, but a mentoring and learning experience conducted by the Miss Iowa Scholarship Program.

TRANSPORTATION, HOUSING AND MEALS
I further understand that I will need to furnish transportation to all Miss Iowa's Rising Star activities. I acknowledge that Miss Iowa's Rising Stars and their families are responsible for their own housing and meals during Miss Iowa competition week.

General Rules and Guidelines
Any Rising Star whose conduct is deemed unbecoming by the Miss Iowa's Rising Stars Committee or Miss Iowa Board will be asked to withdraw from the Miss Iowa's Rising Stars program and will no longer be eligible for future participation. The Rising Stars program fee is non‐refundable.

No one is permitted backstage at any time except security, stage personnel, competition officials and production members. Rising Stars will only be allowed backstage when accompanied by a competition official.

No one will be permitted in the Adler Theatre dressing rooms except authorized personnel. Rising Stars should plan to arrive for the evening portion of the Rising Stars program dressed in production wardrobe, as specified by Miss Iowa's Rising Stars program officials.

Please direct any problems or complaints to the Miss Iowa's Rising Stars Program Coordinator, Andrea Riley, or a Miss
Iowa Board Representative immediately so that they can be resolved in a timely manner.

Please have your Rising Star arrive on time for the Rising Stars program. Tardiness results in scheduling delays and must be avoided.

Please label your child’s belongings before arriving at the Rising Stars program. The Miss Iowa Scholarship Program is not responsible for lost or stolen personal items.

I hereby waive and release the Miss Iowa Scholarship Program Management Corporation from any and all liability for any injuries or illnesses incurred while at the Miss Iowa's Rising Stars program. I will be responsible for any medical or other charges in connection with my child's attendance. I know of no medical or physical problem which may affect my child’s ability to safely participate in this Miss Iowa's Rising Stars program.

Electronic Signature (acknowledging statement of understanding): *