Full
Name________________________________________________
Age as of the day of the pageant________ Date of Birth _________________
Mailing Address___________________________________________
________________________________________________________
E-Mail Address____________________________________________
Parents / Guardian_________________________________________
Phone numbers: _____________ cell Home Work
Tshirt Size: Youth / Adult XS S M L XL
Sponsored By_______________________________________________
I am entering: Baby _____ Teeny_____ Tiny_____ Little
Entry Fee: ------------- $75.00
OPTIONALS:
I am entering Country/Western Wear ___Fee $10.00
I am entering Prettiest Dress _____ Fee $10.00
I am entering Prettiest Hair _____ Fee $10.00
I am entering Prettiest Smile _____Fee $10.00
I am entering Photogenic Natural _____ Fee $10.00
I am entering Photogenic Glamour ____Fee $10.00
Early Bird Special _____ Fee (see info sheet for details)
By participating in this pageant, I release The Miss GA Southern Belle Pageant and the Director from any injury, loss or
theft sustained, or resulting from my participating. I have read and fully understand the rules and regulations and do hereby
release the Miss Ga Southern Belle Pageant, it’s directors and volunteers and the Colquitt County Art Center from all
liabilities, including but not limited to any injury or loss or theft of property during or subsequent to the pageant. I understand
that the judges decisions are final and shall not be contested. Any inappropriate behavior or poor sportsmanship will result
in disqualification from the competition without refund. Only in the event that the pageant is cancelled will refunds be issued.
I do hereby give permission for any or all photographs take to be used for publicity purposes.
_________________________________- Parent/ Guardian Signature
Make checks payable to Miss Ga. Southern Belle Pageant, include a wallet size photo, and mail with completed application
to 3040 GA Hwy 133 South Moultrie, GA 31788
EMCEE SHEET
Division ______________ Contestant #______________
_____________________________________(name) is
the month/year old daughter of
____________________________________________
From
, Georgia.
(Name) has ______________eyes and hair. She is in
the ______grade at _________________________
(school).
Her hobbies include ____________________________
_____________________________________________.
Her favorite TV show is and her favorite movie is
___________________________________.
____________________________(Name)’s favorite
color is ___________________________,
and her favorite food is ________________________.
Three words that best describe ________________
are: _______________ and ____________________
and __________________ . She is sponsored today by
__________________________________________.
