Miss Middlesboro Pageant 2015

This Magic Moment

Pageant Date: Saturday, April 18th
Place: Middlesboro High School Gymnasium
Time: 6:00 pm
Entry Deadline: Thursday, April 9th
Entry Fee: $45.00 Check or money order only
Photogenic (optional): $15.00 Please submit a 5x7 or 8x10 with
application

Age Divisions
1-3 years Wee Miss
4-6 years Tiny Miss
7-10 years Little Miss
11-13 years Jr. Miss
14-18 years Miss

Each contestant will be assigned to the appropriate age division

according to the contestants age on day of pageant
Applications Pickup and Drop off Points:
Middlesboro High School,
West End Primary School
Middlesboro ARH Outpatient Pharmacy
Signatures Hair Salon
Please make checks payable to Miss Middlesboro Pageant

Rules and Regulations:

Parents of contestants must read the following information and sign for
official application to be considered. Parents/Guardians must be able to
provide proof of residency
Contestants must have a current address within Middlesboro City Limits
and/or attend Middlesboro City School, Gateway or St. Julians. All children
under the age of 6yrs are eligible regardless of address
Contestants must compete within their correct age group. Applicants 19yrs
old who are still currently enrolled in high school ARE eligible
Applicants must have never been married or have a child
Formal Wear only all age divisions
Miss Middlesboro contestants will be asked a question about current events
or our community
Mandatory rehearsal Friday, April 17th
Application fees are non-refundable
Miss Middlesboro reserves the right to change rules and regulations
Waiver and Release of Liability
I acknowledge and assume the risks of participating in The Miss Middlesboro
Pageant. I waive, release and discharge from any and all claims or liabilities
for death personal injury or damages of any kind. I agree not to sue any
persons or entities involved with the pageant for any of the claims or
liabilities that I have waived, released or discharged.
My signature certifies that I have read and I understand the information
above, and I am eighteen (18) years of age.
__________________________ _________________________________ ____________
Printed Name
Participants Signature
Date
If under the age of eighteen:
I am the parent or legal guardian of the minor named, and I execute the
foregoing Waiver and Release on behalf of them. I confirm that I have the
legal authority to act for and on behalf of the minor named herein.
__________________________ _________________________________ _____________
Printed Name
Date

Parent/Guardians Signature

For any additional information please visit our Facebook page at Miss
Middlesboro 2015
Need more help please contact Natasha Fuson or Shawnessy Horton

Miss Middlesboro and Little Miss Middlesboro

Registration Form
Name:_______________________________________________________________________
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Address:_____________________________________________________________________
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Phone
Number:________________________________________________________________
Parents:_____________________________________________________________________
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Brothers/Sisters:_____________________________________________________________
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Grade:________________________School:_______________________________________
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Hair Color:_____________________Eye
Color:________________________________________
Favorite Color:_________________Favorite
Food:_____________________________________
Favorite TV
Show/Movie:_________________________________________________________
Extracurricular
Activities/Hobbies:__________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Awards and
Honors:_____________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

Goals/Future
Plans:______________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
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