Name_______________________ Age______ Birthday___________

Parents__________________________________________________

Mailing Address_____________________ Phone________________

Sponsor_________________________________________________

Email Address____________________________________________

School:_____________________________________

Eye Color:_________ Hair Color:__________

Height:____________ Weight:___________

Three words that describe yourself: _____________ ____________ ____________

Color:__________ T.V. Show:______________

Food:_______________

Hobbies:__________________________________________________

__________________________________________________

Special Honors:_____________________________________________

_____________________________________________

School Activities:_____________________________________________

_____________________________________________

Ambition:___________________________________________________

___________________________________________________

*AS THE PARENT/GUARDIAN OF________________________________, I AGREE THE DIRECTORS, PAGEANT COMMITTEE, WAYCROSS MIDDLE SCHOOL, OR ANY OF ITS HOLDINGS ARE NOT TO BE HELD RESPONSIBLE FOR INJURIES, THEFT, OR ACCIDENTS INCURRED DURING, TO OR FROM THE PAGEANT. I ALSO AGREE THE JUDGES DECISIONS ARE FINAL AND ARE NOT TO BE DISPUTED. I ALSO UNDERSTAND THAT IF I ACT IN A DISORDERLY OR DISRESPECTFUL WAY THAT I NOR MY CHILD WILL BE ASKED TO PARTICIPATE IN FUTURE PAGEANTS.

Parent Signature:_______________________________

Signature of contestant:____________________________

Age division entering ($50):__________________

Prettiest Smile ($10):_____ Prettiest Eyes ($10):_____ Prettiest Dress($10):_____

Best Personality ($10):______ Photogenic($10):______

Extra photos ($5):________

Total Amount:___________

Cash:_____ -or- Check #:_______

Mail to: Miss Southern Sweetheart

101 Plantation Dr.

Waycross, GA 31501

Hart Hopkins, director, 912-337-9998