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OFFICAL ENTRY FORM
NORTHERN NEW YORK STARZ PAGEANT
1815 OLMSTEAD DR. 209-A WATERTOWN, NY 13601
Ramada Inn Watertown, Ny 11:00-1:00 I would like to enter the following pageant. I hereby apply for entry and submit the following information:
( ) baby boy 0-12 months; ( ) baby girl 0-12 months; ( ) boy age 2-4
( ) girl age 2-4; ( ) boy age 5-8; ( ) girl age 5-8; ( ) boy age 9-13
( ) girl age 9-13; ( ) girl age 14-17
Entry fees:
ages 0-12 40.00;
ages 2-13 45.00;
ages 14-17 50.00
Name:___________________ Date of Birth ___________AGE______
Address _______________________
City ________________ zip _______
Phone ( )________________
Name of Parents ______________________
Name of Sponsor ___________________
Describe contestant in 3 words ___________, ___________, ___________
Favorite Sports or Hobbies ____________________________________
Favorite Subject in School ____________________________
Favorite Television show_____________________ Foods _______________
If you could be anyone in the world who would you be? ______________________
Name the person in the world you most admire ___________________ Why ____________
For parents with babies please write a paragraph on the back of this form about your baby.
Check if you would like to enter any of the following optionals.
( ) Costume 10.00
( ) Katharina's photogenic 10.00 please bring photo to pageant.
( ) Talent 10.00
( ) Swim Wear 10.00
I do hereby give my permission for my son/daughter to complete and release the Pageant and all associated with it from any responsibility for his/her welfare during the pageant period.
I do/Do not allow any photo/s release if my child is crowned.
_________________________
Date
_______________________________
Signature of Parent/Guardian
Please send entry form and admissions to the above address. Thank you. We hope to see you there.
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