Stars of the Big Top Entry Form:


Name:_______________________________________________

Age:_____   Color of Hair:___________  Color of eyes:_________

Parent’s Names: _______________________________________

Answer questions if age appropriate:

What is your Favorite Circus Act?
____________________________________________________________


Favorite hobby/Activity
_____________________________________________________________

Contestants/parents agree to hold harmless the pageant, directors, or volunteers from possible damages through loss, theft, or injury caused by or during her participation, or to and from the pageant or any related event. We also agree to display good sportsmanship at all time during and after the event. I will comply with this release in every way, and that personal data I have submitted is true and correct. Please sign below.

Parent’s signature_______________________________  Date:___________

Address: _____________________________________

Phone Number (s):_______________________________________________

Email: _______________________________________

CATEGORY (PLEASE CHECK)

____ BABY MISS (0-12mnths.)   ____MINI MISS (13-23mnths..)  ____TINY MISS (2-3)

____TODDLER MISS (4-5)          ____ LITTLE MISS (6-7)            ____ YOUNG MISS (8-9)

____ JUNIOR MISS (10-12)            

PLEASE CHECK CATEGORIES IN WHICH YOU WILL COMPETE AND RETURN ENTRY FORM WITH PAYMENT.

____ (Deadline OCTOBER 14TH.)                $50.00  For all events.
( ENTER BY OCT 7TH TO RECEIVE THIS PRICE)
____After October 7th   $60.00

____PINK LIGHTS OF PARIS DISCOUNT     -$5.00



____TOTAL AMOUNT ENCLOSED





MAIL APPLICATION TO:
APRIL LEWIS
128 PRICE STREET
ALDERSON, WV  24910
PAYPAL ADDRESS: lewisinteriorswv@yahoo.com



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