Contestants First Name:  * Contestants Last Name:  * Division (Choose your age division based on your age as of January 1st 2011) Baby Miss (Ages 0-23 months) Tiny Miss (Ages 2-4 years) Little Miss (Ages 5-7) Petite Miss (Ages 8-10) Junior Miss (Ages 11-13) Teen Miss (Ages 14-16) Miss (Ages 17-23) Mrs (ages 24 and up) Contestant's Date of birth:  * How did you learn about this pageant? Parents:  * Hobbies and Interests (this will be read on stage during your walk):  * Email Address:  * Address:  * City:  * State:  * Zip Code:  * Telephone Number:  * Contestants or Legal Guardian (if under the age of 18) agrees to the following by submitting this form: The judges and tabulators decisions are FINAL. I understand that EVERYONE in our party including the contestant is to be a good sport at all times and that the Miss Heart of America Pageant Program reserves the right to rescind any title and refuse entry to any event due to bad sportsmanship or negative behavior/actions by any titleholder or anyone in their party. I hereby release waive and forever discharge Miss Heart of America LLC its members agents subcontractors employees or assigns or the promoters sponsors or advertisers owners and lessees of premises used to conduct this event and each of them their officers and employees from any and all liability. By initialing I grant the Miss Heart of America Pageant Program the right to use my/my daughter's photo on their website and/or in advertising of the pageant program. I understand that the pageant entry fee is non refundable and non transferable to another pageant or contestant should the registered contestant be unable to attend. I agree to abide by all rules and guidelines and show respect to fellow contestants and our staff. I understand that score sheets will be available for pick up immediately following the pageant but any score sheets that are not picked up immediately following the pageant will be discarded. Score sheets will not be mailed or emailed. I understand that the winners of this prelim will advance to the 2012 North Florida State Miss Heart of America Pageant with their entry fee paid. I certify that the above stated information is correct. Please initial here.  * Email addresses of any friends you think might be interested in our program:  * Do you live outside of the local area? If so where are pageants normally held in your area? We are always looking for new areas to come to!  * Mailing list signup:   Check this box to signup for our site mailing list. Security code:   * Do not enter anything in this field: