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MISS BARSTOW CHILDREN�S PAGEANT Type or Print Neatly ENTRY FORM Division _________________ � Name _______________________________________________________ e-mail ______________________________________________ � Age ___________ Birth Date _________________________ Birth Place ___________________________________________________ � Address ____________________________________________ City _________________________________ Zip _____________ � Home # __________________________ Cell # _________________________ S.S # _________________________________________ � Mothers Name ____________________________________ Fathers Name ____________________________________________________ � Number of Brothers and Sisters _______________________________________ Pets ___________________________________________ � School _____________________________________________ Grade _____ Favorite Subject __________________________________ � Hair Color ________________________________ Eye Color __________________________________ Height ____________________ Favorite Food _____________________________________ Favorite TV Show ________________________________________________ � Hobbies/Interests/Talents ______________________________________________________________________________________________ � ___________________________________________________________________________________________________________________ � ___________________________________________________________________________________________________________________ � Ambition ___________________________________________________________________________________________________________ � ___________________________________________________________________________________________________________________ � Best or Interesting Quality _____________________________________________________________________________________________ � Favorite Actor _________________________________________ Favorite Actress _______________________________________________ � Favorite Cartoon Character ____________________________________________________________________________________________ � Favorite Past Time __________________________________________________________________________________________________ � ___________________________________________________________________________________________________________________ � Sponsors (Person's paying fees)________________________________________________________________________________________ � ___________________________________________________________________________________________________________________ � ___________________________________________________________________________________________________________________ � � (Entry form will be read while child is on stage. Please fill out completely) � MAIL TO: MAKE CHECK PAYABLE TO: Miss Barstow Pageant Miss Barstow Pageant P.O. Box 1631 Barstow, CA 92312 ______________________________ Referred by � |
AGREEMENT: I hereby certify that I have read and understand the refund and check policy and rules for the Miss Barstow Childrens Pageant, Inc. and have retained a copy thereof. I agree to abide by and be bound to the same. I will hold harmless the Miss Barstow Pageant, Inc. and anyone connected with this pageant, for any injury, loss or accident in connection with pageant related activities during or after the pageant, if I choose to become involved in the events throughout the year. I further permit any photos or videos/DVDs of my child to be used for publicity and promotional purposes. ____________________________________________________________________________________________________ Name of Entrant (PRINT) __________________________________________________________________________________________________ Parent or Guardian (PRINT) _____________________________________________________________________ _________________________ SIGNATURE OF PARENT OR GUARDIAN DATE |