Contestant Information

PLEASE Select PAGEANT
Ohio-Michigan, April 23, 2005 Tri-State Indiana, May 7, 2005 Florida Open State, May 22, 2005 Kentucky Open State, July 10, 2005

Name

Birthday      Age Group

Address

City      State     Zip

Phone

Hair      Eyes

Hobbies    

Pets

Parents

Referred by

ENTRY FEES

I have read the rules and regulations of this National Pageant and fully understand and agree to abide by them. I hereby release the staff of Dixieland Dolls and Darlings and the facility where the pageant is being held from any theft, injury or loss of property, before, during and after competition. I understand that any act of bad sportsmanship will result in disqualification without refund. I agree and allow any pictures of my child to be used for promotional use.

Signature   Date