Tiny, Little, and Miss Huckleberry 2009 Registration Form

Complete the appropriate sections below.
First name: Last name:
Grade next fall: # of years in pageant:
Home Phone: Age:
Parents work #: Birth Date:
Parents name:
Please include area code

Medical Information:

Please check all those that apply, and explain and list medications below:

Medications
Limiting condition
Special diet
Chronic illness
Allergies
Surgery in the past year
Other

Explain & List:
   

I give permission for                                                          to participate in the Pageant and its activities and authorize Ashley Wiltse and her mother, Judy Wiltse, supervising these activities to administer emergency treatment to her for any accident or illness and to act in my stead in approving necessary medical care.


Parent/Guardian Name (please print)                                                                      

Signature of Parent/Guardian                                                                      

Date                            

All girls will be expected to treat one another with respect and kindness. There will be no put downs or teasing. We will learn from one another and help one another. There will be no foul language spoken in practices and there will be no foul language in performances. All music must be approved by me first.

Signature of Participant                                                                      

Date                            


This information will be submitted using your e-mail application. It is being sent to the Festival webmaster. This form collects no other information except that contained in the above form.
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