Tiny Miss Jackson – Ages 3-4

Little Miss Jackson – Ages 5-8

Pre-Teen Miss Jackson – Ages 9-12

(Age as of the day of the Pageant)

Name___________________________________________________________

Age__________________________  Date of Birth________________________

Parent’s Name____________________________________________________

Address_________________________________________________________

City, State and zip code_____________________________________________

Telephone number_____________________ Cell Number__________________

Email Address____________________________________________________

School attending_______________________________ Grade______________

Hair Color_________________________ Eye Color______________________

Hobbies, Sports, Activities, Special Interests:

Mail Entry Form, 1 picture and fee ($45.00) to:

Miss Jackson Pageants

P.O. Box 85

Jackson, MO 63755