Kimberton Community Fair Queen
Registration Form

Contestant's Name: 

Address:

City: Postal Code:

Phone Number:  

E-Mail Address:

Parent's Names:

Birthdate:  SS#

School Attending:

Grade:  

Major:

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?

What hobbies do you enjoy?

Is there anything else you would like to tell us?

By submission of this application, I hereby acknowledge that I have read the official rules and regulations and that I am complying with them in every way and that the personal data as set forth is correct.

Contestant's Signature:

Parent's Signature: