Full Name

Local Title

Eye Color

Hair Color

Hometown

School Attending(if applicable)

Year of Graduation

Major

Ambition

Ambition contd

Pets

Siblings

Most interesting spot in hometown

Most famous I've met

Person I would like to meet & why

Person I would like to meet & why contd

Best Advice I've ever received

Best Advice I've ever received contd

My greatest achievement

My greatest achievement contd

My secret to success

My secret to success contd

People would be surprised to know

People would be surprised to know contd

What makes me happy

Biggest extravagance

One thing always in my refrigerator

My best trait

My worst trait

I never leave home without

Beauty Tip

Favorite Celebrity

Favorite Movie or TV Show

Favorite School Subject

Favorite Song or Music Group

Favorite Sport or Activity

Favorite Vacation

Favorite Gift Received

Signature of Contestant

Signature of Contestant-39-11-1

Signature of Parent/Guardian(if Contestant is under 18)40-12-2

Signature of Contestant-41-12-1

Printed Name(Parent/Guardian)42-12-2

Date(Contestant)43-12-1

Printed Name(Contestant)44-12-1

Signature of Parent or Guardian-45-13-2

Signature of Contestant-46-13-1

Parent or Guardian Name-47-13-2

Contestant's Name-48-13-1

Policy and Group Number-49

Phone

Name of medical insurance carrier-51

List any and all handicaps or impairments that apply to you-52

If so please explain-53

Have you recently had any serious illness accident or surgery contd 54

Have you recently had any serious illness accident or surgery 55

If so explain-56

Do you have any ongoing conditions for which you are currently taking medication or being treated for-57

Additional medicine information not previously stated-58

List any all medicine that you are currently taking prescription or nonprescription contd 59

List any all medicine that you are currently taking prescription or nonprescription-60

If so list-61

Are you allergic to any medication or foods-62

Physician Phone Numbers-63

Family Physician-64

Emergency Contact Phone Numbers-65

Emergency Contact Address-66

Relationship-67

Emergency Contact-68

Parent/Guardian Names if Contestant is under 18 years-69

Full Address-70

Date of Birth-71

Mess-72

Cell

Todays Date-74

Contestants Full Name-75

Signature of Parent/Guardian-76-14-2

Signature of Contestant-77-14-1

Date_2-78-12-2

Parent/Guardian Printed Name-79-14-2

Printed Name of Entrant-80-14-1

Parent's Signature(if Contestant is in the TEEN division)-81-15-2

Contestant's Signature-82-15-1

Todays Date_2 83-15-2

Parent/Legal Guardian SIGNATURE-84-16-2

Parent/Legal Guardian PRINTED NAME84-16-2

Contestant's SIGNATURE-86-16-1

Contestants PRINTED NAME-87-16-1