DATE :

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LAST NAME:       FIRST NAME: MIDDLE INT:

ADDRESS: CITY: STATE: ZIP

HOME PHONE: ALTERNATE PHONE:

EMAIL ADDRESS:

HAIR COLOR: EYE COLOR:    BIRTH DATE:  AGE:

SCHOOL CURRENTLY ENROLLED:  GRADE ENTERING IN FALL:

PARENTS NAME:

THREE WORDS THAT BEST DESCRIBE YOU:   

SPECIAL INTEREST:

 

I agree to abide by all rules and regulations set by the Dale County Pageant Committee and in accordance with the National Peanut Festival. I understand that all Judges decisions are final and Bad Sportsmanship will not be tolerated. I certify that neither the Dale County Pageant nor the facility will be held responsible for any damages, loss or injuries before, during, or after the Pageant and I release any liabilities to them.

 

                                                                  

SIGNATURE OF PARENT OR LEGAL GUARDIAN                                                                                                               DATE

MAIL FORM AND FEES TO:

DALE COUNTY PAGEANT

C/O JENNIFER WATSON

105 FRANKWOOD DRIVE

MIDLAND CITY, AL 36350

PHONE (334) 678-5549

www.dalecountypageants.com

 

 

SUBMIT