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Contestant #________________________ Age Division___________________ Name________________________________________________Age_______________ Parents______________________________________________________Phone________________ Parents______________________________________________________Phone________________ Address:____________________________City___________________State____________Zip__________ School_________________________________________________Grade___________ Special Interest_________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ Ambition________________________________________________________________________________ ________________________________________________________________________________ Sponsored By____________________________________________________________________________
---------------------------------------------------------------------------------------- Pageant Waiver My daughter_________________________________has my permission to enter the 2010 "Miss Georgia Marble" Pageant to be held on September 11, 2010. I hereby signify that I understand that Bethany-Salem Fire Dept., its volunteers, the owner of property of where she will participate in the Pageant and all persons connected with this event are not to be held responsible for any injuries, loss of or damaged property which we may suffer while taking part in this event or as a result thereof. I understand that all decisions made by the Judges are final. ___________________________________________ _____________________ Signature of Parent/Guardian Date Mail To:
Bethany-Salem Fire Dept. c/o Tim Prather 135 Franklin Court Jasper, Georgia 30143
Do not mail photographs..Do not mail photographs
Application must be received in hand by September 11,2009. | ||||||||||||