Little Mister/Miss Contest

Camden Point Freedom Festival

Sponsored by: Bank of Weston

Camden Point Community Center

Saturday, June 26, 2010 Time: 3:30

Theme: Patriotic

Registration form Deadline is June 19, 2010

Please send to Stacey Payne at PO Box 201, Camden Point, Mo 64018

Any questions please call 816-210-3180

Child’s Name: (Mister or Miss)______________________________________

Parent’s Name: __________________________________________________

Address: _______________________________________________________

Phone:_________________________________________________________

Birth Date:_____________________ Age (as of June 30th):________________

Nickname:_____________________ Favorite Toy:______________________

Special Interest: __________________________________________________

Summer attire is suggested, but please no bathing suits. No props will be allowed. Age divisions are of June 30th (same as Missouri School regulations). Ages are 2 years, 3 years, 4 years and 5 years. The liability waiver must be signed by parent or guardian before any child may enter the contest.

Liability Waiver: Neither the Freedom Festival Committee, City of Camden Point, or Fire Protection District, respective representatives or agents will be responsible for any injury or damage to any contestant or their representative while within Freedom Festival Jurisdiction or during any part of the Festival’s activities. Furthermore, contestant ( or representative) shall, and does by means of this agreement, covenant and agree to indemnify and hold harmless the said above parties of any and all liability that may arise out of bodily injuries or property damage.

______________________________________ ______________

Parent Signature Date

Continued on other side

Camden Point Freedom Festival

The Camden Point Freedom Festival Committee would like to use photos of the festival as advertisement and future display. I hereby grant the right and permission for CPFF to copyright and/or use, reuse and/or publish, and republish photographic pictures of me on reproductions made though any media, for any purpose whatsoever; including the use of any printed matter in which my photo may be used.

I understand that I will not be compensated for the use of my photograph and that my image will not be sold by the CPFF to any other agencies. I further understand that my name may be used in conjunction with photograph(s) used. I hereby release, discharge and agree to save harmless photograph, the CPFF and firm publishing or distributing the finished product which bears my image.

I have read the above release, authorizations and agreement before affixing my signature below, and warrant that I fully understand the contents thereof.

1.Date:_________ 2. Child’s Name(Please Print:______________________________

3. Legal Signature(or signature of parent/guardian):____________________________

4. Address/City/State/Zip:_________________________________________________

For parents of small children: I hereby certify that I am the parent and/or guardian of________________________ and give my consent that any photographs of this child may be used as set forth in the release above.

Parent/Guardian Name (Please Print):________________________________________