Mr. Cy-Creek Pageant

ESCORT

Entry Form

Applicant’s Full Name: ________________________________________

Applicant’s email: ___________________________________________

Grade Level: _____ Cell #: _____________ Hm #: ________________

Parent’s Name: _____________________________________________

Parent’s Home #: _____________ Parent’s Cell #: ________________

Parent’s Email: _____________________________________________

___ I have read and agree to all terms and conditions stated on the attached sheet. I understand that if I am chosen as an escort I will owe an additional $30 fee.

____________________________________ _________

Student Signature Date

Chances are $25 Each

I would like to purchase _____chance(s) at $25 each. Enclosed is a check or cash totaling $25 x the number of chances I would like to purchase. Purchase of a chance does not guarantee me a spot as an Escort.

Checks payable to SBC. All purchases are non refundable. Entry deadline 3 pm, November 12. Turn forms in at Mr. CyCreek Information table or place in Stacy Jennings mailbox in the staff mailroom.

Total Amount of Money Enclosed: $_________