​Contestants Name: ____________________________________________

Date of Birth: _____/_____/______   Age on date of pageant: _____

Phone Number: (_____)_______-________ and or (____)_____-_______

Mailing Address: _____________________________________

Town/City:___________________ State:________ Zip code: ___________

E-Mail: __________________@____________.com
(If under age of 18)
Mothers Name: ____________________________________________

Fathers Name: ____________________________________________

Contestants Hobbies:
__________________________________________________________________

Ambition For the Future:

__________________________________________________________________

We here by have read and understand all the rules and regulations set forth by the pageant and release the directors and staff from any and all claims for damages or injuries that may sustain while participating in all pageant activities. Sterling Crowns is not responsible for any items missing or stolen during the time of pageant.
We here by give Sterling Crown Pageants permission to publish any photos or video of the pageant weekend for television or publicity purposes. We here by confirm that all information on this form is correct and true.

Mail application and Photograph for optional competition to
P.O. Box 573 Union Maine. 04862.
No later then September 1. 2012.

Contestant Signature: ___________________________________Date:____/____/___

Parent Signature (If under 18):________________________________Date: ___/____/_____