Miss Connecticut Teen and Jr. Teen America Personal History Form

Name:____________________________________________________ Age:__________________

Address:______________________________________Apt. No.___________ Zip:_____________

City:__________________________ County:_____________________ State:________________

Date of Birth: ___________________  SS#_________________  Telephone (H) _______________

T-Shirt Size (Circle)    S       M        L       Hair Color:_______________   Eye Color:____________

School:____________________________________________Year/Grade in School:____________

E-Mail:_______________________________________________________________

Hobbies:________________________________________________________________________

Talent:_________________________________________________________________________

Special Training  _________________________________________________________________

Clubs and Groups you belong to in school:____________________________________________

______________________________________________________________________________

Three Words that describe you:_____________________________________________________

Honors and Awards:______________________________________________________________

Favorite Foods:__________________________________________________________________

Career Goals:____________________________________________________________________

Mother's Name:___________________________________ Occupation:____________________

Address:_________________________________________ Work Phone:___________________

Father's Name:____________________________________ Occupation:____________________

Address:_________________________________________ Work Phone:___________________

How did you hear about the pageant?________________________________________________

Town Title You Are Applying For: ___________________________________________________
Please print this form and fill out completely.  Sign and return with your $45 nonrefundable deposit. 
FINAL MAIL IN DEADLINE IS September 15, 2007.

1. Each Teen entrant must be 14 years old and no older than 18 as of August 1 of national competition year and must not be a full time college student prior to the national pageant.  Each Jr. Teen entrant must be a minimum of 11 years old and no older than 14 years as of August 1 of national competition year.

2. Entrants must be born female, single, never married, nor given birth to a child.

3. Entrants must be of good health and moral character.

4. All decisions as to the eligibility shall be determined by The Miss Connecticut Teen America
Pageant and The Continental Miss Teen America Scholarship Program, Inc.

5. All decisions of the judges are final and irrevocable.

6. Any contestant and/or family member or guest showing unsportsmanlike behavior will lead to
the disqualification of the contestant. No refunds will be given.

7. If for any reason a winner is disqualified, or elects not to participate, her title and all awards will
be passed on to the next choice of the judges.

8. Entrants hereby agree to release unconditionally and forever, any claim against The Miss
Connecticut Teen America Pageant and The Continental Miss Teen America Scholarship Program,
Inc., its officers, directors, employees, agents, subsidiaries, which they may have, by virtue of their
participation in this pageant or any use of their name, likeness, voice and/or biography in connection
with this pageant, including use in promotional and advertising material.

9. The Miss Connecticut Teen America Pageant and The Continental Miss Teen America Scholarship
Program, Inc. reserves the right to change the date and location of the State and/or National pageant.

10. Employees of the Continental Miss Teen America Scholarship Program, Inc. and members of their
immediate families are not eligible to participate in the competition.

11. Entrants agree that if they enter a state preliminary and succeed to a state level title, or to the title
of Miss Teen America 2010 or Miss Jr. Teen America 2010 they will not participate in any pageants
during the time that they hold either of those titles.  They further agree that they will not participate in
any program that will inhibit their ability to compete at the state or national pageant.

12. Contestants and their parents/guardians agree to hold harmless all persons affiliated with the Miss
Connecticut Teen America Pageant and The Continental Miss Teen America Scholarship Program, Inc.,
in case of any loss or injury occurring during, or in travel to and/or from this program.

13. Recipient of the title Miss Connecticut Teen America 2010 and Miss Connecticut Jr. Teen America
2010 promises to promote the program by making a minimum of 12 personal appearances during their
reign. Titleholders further promise to make no personal appearances or appear in any advertising and/or
publications without permission from the State Director, and to return to the 2011 Connecticut State
Pageant to crown her successor.

14. Miss Connecticut Teen/Jr. Teen America 2010 agrees to make no changes to her personal
appearance during the course of her reign, without permission from the State Director.

15. State, local, town and city representatives agree that they accept their titles with the understanding
that they will compete at the next level and assume all responsibility for payment of any fees. All fees
are nonrefundable.

16.  I understand that I may withdraw from the competition at any time, however, I in doing so, must
return my crown and banner to the state office.  Under no circumstances, and not for any reason shall
I be entitled to a refund in whole or in part of any fees paid.  All fees paid to Miss Connecticut Teen
America are NOT REFUNDABLE and NOT TRANSFERABLE in full or in part under any circumstances.
This includes, but is not limited to entry fees, advertising fees, pageant admission ticket sales fees,
guest meal fees and any other fees paid to Miss Connecticut Teen America by anyone including, but
not limited to, delegates, sponsors, and advertisers.

17. City/State crowns and banners remain the property of the Miss Connecticut Teen America Pageant
until after the state/national competition. Any delegate who defaults on her contract must return all awards
including crown and banner to the state office in the condition in which it was received and given to the
next choice of the judges.

18.  I further understand that there will be a $25 fee assessed for any returned check.