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Full Name
Preferred Name
Birthday
Month
Day
Year
Age on Pageant Day
Divisions
Tiny Miss
Little Miss
Young Miss
Pre-Teen Miss
Parent/Guardian Name
Phone
Email
Address
Emergency Contact
Optional Competitions
Talent Performance
Type of Talent?
Title of Music?
Props Needed?
Length of Act (Max 1 Min)
T-Shirt Size for Participants
XS
S
M
L
XL
Date and time
Month
Day
Year
Time
:
Hours
Minutes
AM
By signing below, I give permission for my child to participate in Little Miss 916. I understand that all fees are non-refundable and that event photos /videos may be used for promotional purposes. To proceed please sign Signature
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Registration Fee
$25
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