Registration form applicant name (write name above) you must complete all information in this application and
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2017 MISS AMERICA “SHOW US YOUR SHOES” PARADE DRIVER APPLICATION REGISTRATION FORM APPLICANT NAME (WRITE NAME ABOVE) YOU MUST COMPLETE ALL INFORMATION IN THIS APPLICATION AND ATTACH PHOTO COPIES OF ALL REQUIRED INFORMATION
DRIVER BASIC INFORMATION This page is designed to capture the information as it applies to the actual person driving A car on parade day, as we realize that in some cases the actual driver may not own the parade car, and may be borrowing it for the parade. The person (driver) below will receive the final parade information packet and will be the person who we communicate with! DRIVER NAME: ___________________________________________________________________ MAILING ADDRESS: ______________________________________________________________ CITY __________________________________________ STATE _____________ ZIP _________ BEST PHONE NUMBER TO CONTACT YOU: ___________________________________________ 2ND BEST PHONE NUMBER: ________________________________________________________ EMAIL ADDRESS _________________________________________________________________ DRIVER LICENSE # (PERSON WHO IS DRIVING) _______________________________________ (SEND COPY OF DRIVERS LICENSE) STATE THAT LICENSE WAS ISSUED IN: ______________________________________________ HAVE YOU DRIVEN VEHICLE IN THE PARADE BEFORE? _________ LIST YEARS:___________
VEHICLE OWNER INFORMATION This page is designed to capture the information as it applies to the OWNER of the parade car. We realize that in most cases the owner and the driver are the same, but in other cases the owner and driver are different. VEHICLE OWNER NAME: __________________________________________________________ VEHICLE OWNER INSURANCE COMPANY____________________________________________ (SEND COPY OF DECLARATION PAGE WHICH MUST INCLUDE EFFECTIVE DATES AND LIMITS – THIS MUST BE IN EFECT ON PARADE DAY – DETAILS ARE ON PAGE 4 OF THIS APPLICATION) VEHICLE OWNER INSURANCE POLICY NUMBER______________________________________ VEHICLE OWNER INSURANCE EXPIRATION DATE_____________________________________ DESCRIPTION OF VEHICLE:________________________________________________________ (SEND PHOTO OF CAR) WEIGHT OF VEHICLE:_____________________________________________________________ MAKE ________________________________ MODEL ______________________________ YEAR ________________________________ COLOR ______________________________ TAG # ________________________________ STATE _______________________________ VIN # ___________________________________________________________________________ ALSO INCLUDE A COPY OF THE FOLLOWING DRIVING RECORD DOCUMENT (Please contact the Division of Motor Vehicles to obtain YOUR driving history record and attach to this document – NOT the car owners driving record, not unless you own the car and drive the car) This document is required for every single driver (the person behind the wheel on parade day – not the car owner) of any vehicle on the Boardwalk. INSURANCE DECLARATION SHEET (Please include a copy of the “declaration sheet” from the CAR DRIVER’S Insurance Company listing the coverage)
This is required in order to obtain a boardwalk vehicle permit. A City Ordinance REQUIRES vehicles on the Boardwalk to carry a minimum auto liability limit of:
$300,000 Auto Liability/ Each Occurrence $50,000 Property Damage/Each Person/Each Occurrence
THIS IS FOR THE VEHICLE (NOT THE DRIVER) YOU MUST READ AND SIGN THIS PART OF THE DOCUMENT AND RETURN BACK TO OUR OFFICE – BY SIGNING THIS AGREEMENT YOU ARE STATING THAT YOU UNDERSTAND AND AGREE WHAT HAS BEEN ASKED OF YOU ON AND PRIOR TO PARADE DAY. 1. Please understand you may need to present your driver’s license and insurance card on parade day for inspection. 2. The use of cell phones during the parade is prohibited (only in an emergency) 3. You must be prepared for “wet weather” as the parade will take place RAIN or SHINE. 4. Please make certain you have checked the following before parade day: Your vehicle battery Your alternator Your cooling system Hoses are in good condition Coolant level is in good shape (The parade moves slowly – so keep that in mind) You have a full tank of gas All tires are in good operating condition Check the Oil Make certain the vehicle is clean inside and out and free of dents and rust
9. IF YOUR VEHICLE BREAKS DOWN ON THE PARADE ROUTE: It is important that you do not block the parade route. If you anticipate a problem, you should pull off to the side at one of the ramps along the West side of the boardwalk. Remain in this location till the end of the parade to obtain assistance in being removed from the boardwalk.
In this packet. This also must be returned to our office. 12. IF SELECTED FOR THE PARADE, you grant the MAO and Parade Producers permission to use your entry for any type of need in the parade. 13. I (Vehicle owner name) _____________________________ grant permission to (Driver name) ___________________________________ to use my car for the Miss America “Show Us Your Shoes” Parade. PLEASE MAKE A COPY OF THIS ENTIRE SUBMISSION PRIOR TO MAILING BACK TO OUR OFFICE FOR YOUR RECORDS VEHICLE DRIVER NAME_________________________________________________________ SIGNATURE___________________________________________________________________ DATE________________________________________________________________________ VEHICLE OWNER NAME________________________________________________________ SIGNATURE__________________________________________________________________ DATE________________________________________________________________________ PLEASE POSTAL MAIL ONLY (NO PDF’S OR EMAIL) THIS DOCUMENT ALONG WITH THE APPROPRIATE ATTACHMENTS TO: MISS AMERICA PARADE C/O UTSP 882 SOUTH MATLACK STREET, SUITE 202 WEST CHESTER, PA 19382 DUE DATE – IMMEDIATELY DEADLINE – JUNE 30, 2017 PLEASE NOTE BY MANDATE OF THE CITY OF ATLANTIC CITY - YOU CANNOT SWITCH OUT VEHICLES AND USE A DIFFERENT VEHICLE ON PARADE DAY!!! THE PAPERWORK YOU COMPLETE FOR YOUR PARADE VEHICLE MUST BE THE ONE YOU USE ON PARADE DAY!
2017 Participant Waiver of Liability/Consent for The Miss America SHOW US YOUR SHOES Parade The undersigned will appear/participate in the Miss America Parade given by the Miss America Organization on Saturday, September 9, 2017. The parade is being given as a public service. I assume any and all risks associated with participating in the event and particular activities that I agree to undertake, including but not limited to, negligent or reckless acts by other participants and volunteers, all such risks being known and appreciated by me. I also agree to abide by the rules of the events as set forth by designated officials, producers, and supervisors. Knowing these facts, and in consideration for being permitted to participate in the parade, I hereby, for myself, and on behalf of the members of my organization and my heirs, executors, administrators, successors, assigns, or anyone else who might claim on my behalf, covenant not to sue, and waive release and discharge the City of Atlantic City, Miss America Organization, Under the Sun Productions Inc., CRDA, any and all parade sponsors, and each of them, their officials, directors, employees, volunteers, agents, designated event supervisory personnel or anyone acting for or on their behalf, from any and all losses, costs (including without limitation, litigation costs, and attorney fees), claims, damages, suits, actions, demands, liability, and expenses of every kind and nature in connection with loss of life, personal injury and/or property damage of any kind whatsoever, in law or in equity, arising out of or in the course of my participation in the event. The undersigned does hereby release his/her voice, biography, audio/visual clips and likeness(es) solely in connection with the promotion, advertising for this year and subsequent festivals, and archival use of the Parade (including audio, film, video/DVD, print, radio, television, and Internet advertising and promotions, including promotional materials). The undersigned hereby grants Miss America Organization the right to broadcast, and /or to authorize others to broadcast, via radio, television, cable television, Internet, or otherwise. Clips provided that any such broadcast will be solely for purposes of promoting the Parade. Undersigned acknowledges and agrees that prior to, during or after the Parade, producers may, but will not be obligated to, disseminate information and various materials concerning the Event via the Internet, various online services or through other means or media. The undersigned understands that the Parade is being given for the entertainment of children and the public, and no consideration is being paid to the undersigned. The undersigned hereby accepts sole responsibility for the conduct and operation in the parade. The undersigned agrees that he/she/it will not involve or conduct themselves in any manner that would negatively impact the good reputation of the parade. The undersigned agrees to be legally bound hereby. Vehicle Owner Name ____________________________________________________________________ Address ______________________________________________________________________________City _____________________________________________ State ___________ Zip _________________Date _________________________________________________________________________________ Signature _____________________________________________________________________________ Vehicle Driver Name ____________________________________________________________________ Address ______________________________________________________________________________City _____________________________________________ State ___________ Zip _________________Date _________________________________________________________________________________ Signature _____________________________________________________________________________ DRIVER APPLICATION CHECK LIST: PLEASE RETURN THE FOLLOWING _____ ENTIRE DRIVER APPLICATION DOCUMENT (MAKE A COPY FOR YOUR RECORDS)
_____ COPY OF DRIVERS LICENSE (OF THE DRIVER NOT THE CAR OWNER)
_____ COPY OF VEHICLE INSURANCE CARD (FOR THE VEHICLE NOT THE DRIVER)
_____ COPY OF INSURANCE DECLARATION SHEET WITH LIMITS (FOR THE VEHICLE NOT THE DRIVER)
_____ PHOTO OF VEHICLE _____ COPY OF DRIVING RECORD (THE PERSON DRIVING THE CAR NOT THE CAR OWNER) - - Directory: wp-content -> uploads -> 2016 2016 -> 2017 afoCo Landmark Scholarship Program 2016 -> Instructions for the Preparation of Camera-Ready Contributions to the Conference Proceedings 2016 -> Step student Scholarships for Year 10-13 2016 -> The united church of canada 2016 -> Idan raichel biography – May 2016 Brief Producer, keyboardist, Lyricist, composer and Performer Idan Raichel 2016 -> An introduction to centre’s interventions expanding access to justice 2016 -> Sanchar Shakti 2016 -> Unit analysis should help here. We want number of bananas 2016 -> The Autobiography of Elder Joseph Bates 2016 -> The Great Heat and the Rhode Island Deep Water Bay Scallop (Argopecten irradians) Fishery 1875-1905 Download 222.7 Kb. Share with your friends:
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