Teens to Queens Workshop June 28Th- June 30Th, 2017
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Teens to Queens Workshop June 28th- June 30th, 2017. 9am-12pm Participation Requirements: * $200.00 Participation Fee * Between Ages 12-16 * Completed Registration Packet * All Funds and Forms * Energetic and Enthusiastic Attitude Workshop Includes: * Introduction to the Miss Oregon State and Local Volunteers/ Directors * Meeting Miss Oregon 2016, Miss Oregon’s Outstanding Teen 2016 as well as this years Contestants *Free Entrance to the Princess Tea- Featuring Katie Harman Ebner, Miss America 2002 *Official T-Shirt * Three days of Workshop Seminars which is designed to help you with: -Communty Service/ Platform Development -Resume and Paltform Paperwork Construcution -Interview and Public Speech Development -Talent selection and presentation Tips -Signiture Style/ Personal Branding Tips -Walk the Runway- All the Time -Scholarships. Questions/ reserve you spot: Questions can be directed to Stephenie West, Executive Teen Director, at [email protected] Send your completed registration information via email or Mail to: Teens to Queens Camp: 51195 SW Klompen St. Scappoose, OR 97056 Official Workshop Agenda to be given at Check-in, 9:00am, June 28th, 2017! We look forward to seeing you all in Seaside! 1 Teens to Queens Registration Forms and non-refundable payment must be received on or before June 21st, 2017 *Keeping a copy of completed/ submitted forms for reference is recommended. Teen Name: Home Phone: Cell Phone: Parents Names: Address: City: State: Zip Code: Birth Date: Age on 8/1/2017: School: Grade: E-Mail Address: Who may we thank for referring you to our Teen Workshop: Wardrobe: Teens are provided with one Official Program T-shirt. if you would like to purchase any additional t-shirts, they are an additional $25.00. Check Teen shirt size: XS S M LG XLG ( 2/4 ) (6/8) (10/12) (12/14) (16/18) *Media Waiver: By signing this application, I agree to have my daughter’s name and picture appear in publicity photos affiliated with the Miss Oregon Program. Signature: Date: Parent or Guardian Signature: Date: Teen Participant 2 Rules of Conduct: The Rules of Conduct for Teens and Parents, while at workshop, are the foundation upon which the image and reputation of the Miss Oregon’s Outstanding Teen Program are built and will continue to serve as the basis for its operation. Rule 1: Participants will conduct themselves with dignity, grace and good manners of young women who exemplify the integrity of American youth at all times. Rule 2: Participants will treat all fellow participants, including volunteers and committee members, with courtesy and respect. (* The Miss Oregon’s Outstanding Teen Program has a strict “No Bullying” policy.) Rule 3: Participants must observe all rules and regulations at all meetings, rehearsals, events and performances as well as when in public and especially when wearing the official t-shirt or other program wardrobe items. Rule 4: Participants will not participate in any interview, picture, press contact or any types of publicity unless a member of the Miss Oregon Board of Directors is present and/or arrangements were made with Teen Director, Stephenie West. Rule 6: When participants leave all events, activities and meetings related to the Miss Oregon Teens to Queens Workshop, participants must formally check-out with a Program committee member. I HAVE READ THE ABOVE “RULES OF CONDUCT” FOR THE MISS OREGON’s OUTSTANDING TEENS TO QUEENS PROGRAM, AND I UNDERSTAND AND AGREE THAT THE MISS OREGON SCHOLARSHIP PROGRAM RETAINS ALL RIGHTS TO REGULATE VIOLATIONS AS THEY SEE FIT TO PROTECT THE OTHER PARTICIPANTS AND THE REPUTATION OF THE MISS OREGON SCHOLARSHIP PROGRAM. Signature: Teen Participant Signature: Parent or Guardian 3 2017 HEALTH INFORMATION FORM Date: Teen Name: Home Phone: Father’s Name Phone #s (Office) (Cell) Mother’s Name Phone #s (Office) (Cell) Please list any medical problems that we need to know about: Family Physician: Phone: Allergies: List any medications you are taking, do any need to be refrigerated? Yes No *If yes, what are they? Do you have any special dietary needs? *If so, what do we need to accommodate you? EMERGENCY CONTACT other than parents: (Home and Cell preferred) Name: Home Phone: Cell Phone: Relationship: Work Phone: Medical Consent Parental permission for treatment, in case of emergency is needed. Parents or Guardians please sign the consent below on behalf of your daughter. In case of emergency, I hereby give my permission to any medical personnel to treat my daughter I understand that every attempt will be made to contact me during this event. Signed: ______________________________________________ Date: __________________ 4 Teens to Queens Payment Form Registration Cost: $200.00 *Also include any additional fees based on your forms from above (extra t-shirts). Please make checks payable to the Miss Oregon Program, and send with your registration information to: Miss Oregon’s Oustanding Teen Program Teens to Queens 51195 SW Klompen St Scappoose, OR 97056 Or… Pay by credit card: Credit payments will be available at workshop check-in. Pre-payment cannot be accepted without complete credit card information. Please note: 3% fee to process card MC VISA Number: Expiration date: Security Code: Name as it appears on credit card: Credit card billing address: City: State: Zip: Phone: Email: I hereby consent to a one-time transaction of $ plus any credit card fees, by the Miss Oregon Scholarship Program. Cardholder’s Signature/ Date: ___________________________________________ 5 .