Phillips Czechoslovakian Community Festival Committee, Inc.

                                 MISS CZECH-SLOVAK WISCONSIN STATE PAGEANT

                                                          PERMISSION SLIP

                                           LITTLE SISTER SHADOW PROGRAM

NAME__________________________________________

PARENT(S) ____________________________________________

COMPLETE ADDRESS______________________________________________________

AGE____________                 BIRTHDATE:_________________

HEIGHT:___________ (Helps in matching candidates)

CZECH, SLOVAK OR MORAVIAN FAMILY HERITAGE: YES/NO:________

TELEPHONE No______________________

E-Mail Address____________________________________________

I understand the expectations and obligations as set forth in the rules and Regulations of the Miss State Pageant Little Sister (Shadow) Program.

I am willing to cooperate and assist my daughter in fulfilling these expectations and obligations.

Parent(s) Signature(s) ____________________________________ Date ______________

                                    ___________________________________