Miss Fireworks Entry Form

Pageant Date: April 13, 2024

Schedule and Timing of Pageants

Baby and Children's Pageant (Girls ages 0-15 and Boys ages 0-4) 10:00 a.m.

Miss Fireworks Pageant 6:30 p.m.

Location: Rhema Christian Center, Lewisburg

Contact: Charlotte @ 304-661-4567 or Doris @ 304-667-7817

*All age categories will fill out this same form.

Pertaining to Miss Fireworks (16-21) only:

*To comply with WVAFF rules, the queen contestants must be 16 by the date of the pageant (April 13, 2024) and cannot have turned 22 before January 1, 2025.

**Local Residents only for the Miss Fireworks (16-21) age group: Contestants must reside (full or part-time) in Greenbrier, Summers, or Monroe Counties

Please click this link to download the pageant information sheet:

Pageant Information Sheet

Have you read through and saved the information sheet above?*

Yes

Contestant Name*

First NameMiddle NameLast Name

Name as you wish to be used on stage:

Person filing out this form - If not the contestant.

Phone Number*

Area CodePhone Number

Email to receive updates*

example@example.com

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Which county does the contestant reside in (either part-time or full-time)?

Miss Contestant (16-21) are required to live in one of these counties.

Which pageant is this contestant entering?*

Miss Fireworks (16-21)Senior Miss Fireworks (13-15)Junior Miss Fireworks (9-12)Little Miss Fireworks (5-8)Toddler Miss Sparkler (Girls 2 - 4 years)Tiny Miss Sparkler (Girls 12 months - 23 months)Baby Girl Sparkler (Girls 0 - 11 months)Baby Boy Sparkler (Boys 0 - 23 months)Mister Sparkler (Boys 2 - 4 years)

Contestant Birthday*

Date

Contestant Age*

Name of Parents

School Attending (if applicable)

Contestant Employer or Occupation (If applicable)

School & Community Activities (include awards and honors)

Hobbies*

Personal accomplishment you are the most proud of:

Three Words that Best describe you:*

Why do you want to be Miss Fireworks? (or hold one of the other titles)*

Miss Fireworks Pageant Application

Payment Options