First Name: Last Name:
Guardian's name Email:
Home Phone Number: Cell Phone Number:
What High School do/did you attend: Grade:
What are your plans for the future?
What clubs or activities are you involved in at school?
What community/church activities do you participate in, if any?
What hobbies do you enjoy?
Why do you want to be the Kimberton Fair Queen?
I hereby acknowledge that I have read the Fair Queen Contest Rules, Guidelines & Obligations. I will comply with them in every way and the personal data as set forth is correct. I further understand that pictures and video will be taken of all individuals participating in the Kimberton Fair Queen Program and hereby grant Kimberton Community Fair permission to use my likeness in photographs and videos, without payment or any other compensation for the promotion of the Fair and Fair Queen Program.
I hereby certify that I am the parent/guardian of the above named contestant, and do hereby give my consent without reservation to the Kimberton Community Fair.
Please return form to Louise Kritzberger – Kimberton Community Fair; Queen Contest; 1183 S. Evergreen Drive, Phoenixville, PA 19460 – No later than June 15, 2015. If there are any questions concerning this contest you may contact me at 610-935-8358 or by email at email@example.com and I will be more than happy to assist you in any possible way.