Miss Pennsylvania Belles Application

Miss Pennsylvania Belles Application

For more information about the Miss Pennsylvania Belles, contact Kelly Moyer, Belles Coordinator at misspabelles@gmail.com or 610-468-2145.
“Miss Pennsylvania Scholarship Foundation, Inc.

Presents,The Miss Pennsylvania “Belles,”

state chapter of the Miss America Little Sisters program

The Miss Pennsylvania “Belles” Program is designed to introduce young ladies, ages 5 through 12 years of age, to Miss Pennsylvania, Miss Pennsylvania’s Teen and the Miss America Little Sisters program, which is one of the largest scholarship programs in the world. In fact, the Miss PA Scholarship Foundation awards over $70,000 in scholarships and awards each June at the state competitions held in York, PA.

This program allows young girls to work closely with Miss Pennsylvania and Miss Pennsylvania’s Teen candidates who will serve as their role models and mentors. They will be on stage at competition, and learn poise, grace, and confidence.

During Miss Pennsylvania week 2025, the Miss Pennsylvania Belles will be featured at the “Belle of the Ball” Party with the 2025 Miss Pennsylvania and Miss Pennsylvania’s Teen candidates and receive their official Miss America Little Sisters crown and sash. During our rehearsal days Wednesday through Saturday, the Belles will learn and rehearse a dance number with Arianna Spurlin, Miss Pennsylvania’s Teen and Page Weinstein, Miss Pennsylvania and be featured during the preshow of all three nights of competition, June 19, 20, & 21, 2025 at the Appell Center for the Performing Arts, York, PA.

There will also be additional activities for the Belles to participate in during the week.

Miss PA Competition Dates: Thursday, June 19, Friday, 20, & Saturday, 21, 2025 at the Appell Center for the Performing Arts, York, PA.

For more information about the Miss Pennsylvania Belles, contact Kelly Moyer, Belles Coordinator at misspabelles@gmail.com or 610-468-2145.
Miss Pennsylvania “Belles” APPLICATION FORM & PAYMENT INFORMATION

DEADLINE TO REGISTER Friday, May 15, 2025

Please fill out the following:

Name of Belle:

Age of Belle,* Date of Birth:

*Belle may NOT be younger than 5 years or older than 12 years by June 1, 2025.

Address:

City, State, Zip:

Applying Parent/Guardian Name:

Applying Parent/Guardian Cell Phone # Work Phone #

Contact email address:

Represented by Local Organization? List Org. Name __________________________________

Local Miss/Teen Title and candidate name associated with____________________________

Registration Fee: $300 non-refundable registration can be made at misspa.org by check, PayPal at Misspa.org/donate (Please put PA Belles in the notes line) or check payable to Miss PA Scholarship Foundation, Inc., 180 Rosalia Circle, York, PA.
Belle's Name As you would like it printed in the souvenir magazine

First NameLast Name
Belle's Age Belle may NOT be younger than 5 years or older than 12 years by June 1, 2025.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian's Name

First NameLast Name
Parent/Guardian's Email
example@example.com
Parent/Guardian's Phone Number
Please enter a valid phone number.
Represented by Local Organization? List Org. Name
Local Miss/Teen Title and candidate name associated with
Youth T-Shirt size
The $300.00 non-refundable registration includes:

·         1 Non-refundable Ticket for the “Belles and Bow” Party on Tuesday, June 17 at 6:30pm at the Yorktowne Hotel. More information will be available closer to June.

·         1 Non-refundable Ticket for Belle to attend Miss Pennsylvania Competition for each night at the Appell Center for the Performing Arts, York, PA

·         Crown and Sash (If Belle has participated before there is a $25 discount as she can reuse her sash)

·         Photo and name in the Miss PA Competition Magazine (official program book)

·         Opportunity to be featured in her own Showcase Page section. With any Full page Showcase page submission, Belle will receive a complimentary Miss PA Competition Magazine
What are Miss Pennsylvania Belle Showcase pages?

Showcase pages encompass three types:

• Promotional pages – showcase your princess/star in a very up close and personal way

• Good Luck pages – family and friends can wish her well and show their support

• Business ads – hometown businesses can promote their business and receive in return marketing and promotion by you on your social media

Souvenir Magazine Ad Order Form

·         Ad Sizes Width/Depth in inches (Check your size of ad)

·         300 dpi @100% for size

·         Ads must be PHOTO READY

·         Finished ads are to be electronic and saved as a jpeg., tif., png.
Check Your Size Ad:

Full: 8-1/2 x 11, $300.00blanks Half: 8-1/2 x 5-1/2, $150.00blank fields and text.

Deadline to submit pages: May 15, 2024
Email pages to debbiebutcher@yorklinks.net
Belles Showcase Page Upload

Cancelof
PHOTO/VIDEO RELEASE AGREEMENT

I hereby grant to the Miss PA Scholarship Foundation, Inc. and to its agents, the right to

photograph/video my daughter and use the photo/video and or other digital reproduction of her

or other reproduction of her physical likeness for publication processes, whether electronic, print,

digital or electronic publishing via the Internet.
Belles Name

First NameLast Name
Parent/Guardian Signature

Clear
Photo UploadPlease provide one (1) COLOR headshot, a high-resolution jpg or tiff photo. Be sure your daughters face is lit well! Photos should be head and shoulders only

Cancelof
HEALTH INFORMATION FORM

Parents will be responsible for providing any and all health care needs. If Belle is required to take daily medication, we MUST receive a medical release authorizing a Miss PA Scholarship Foundation Committee member to administer the medication.

NOTE: This information is needed to assist in treating ONLY IF any problems arise.
Belle's Name

First NameLast Name
Parent/Guardian and or emergency contact

First NameLast Name
Phone Number
Please enter a valid phone number.
Email
example@example.com
Physician's Name

First NameLast Name
Physician's Phone Number
Please enter a valid phone number.
Parent/Guardian Signature

Clear
STATEMENT OF UNDERSTANDING

We will ensure that our daughter will conduct herself in a proper manner at all times. We understand that this is NOT a competition, but a mentoring and learning process conducted by the Miss PA Scholarship Foundation and agree to all decisions made by the Miss PA Scholarship Foundation, Inc. Board of Directors relative to the Miss Pennsylvania Belles program.

Transportation, Housing & Meals

All Miss Pennsylvania Belles and their families are responsible for their own housing and meals during the Miss Pennsylvania Scholarship Competition week.

We further understand that we will furnish transportation, meals and housing while participating in the Miss Pennsylvania Belles Program.
As parent(s) of blanks we are submitting her application for approval.
Parent/Guardian Signature

Clear
HOLD HARMLESS AGREEMENT

Acknowledged (by witness of their signature below) her application to participate in The Miss Pennsylvania “Belles” program on June 11-17 at the Yorktowne Hotel and the Appell Center for the Performing Arts and other locations used for appearances the Miss PA Scholarship Foundation will host on behalf of the Miss Pennsylvania “Belles” program.

As part of her participation in this event, it is the Miss Pennsylvania Belle’s responsibility to confine and amend her performance to adapt to the constraints of the production requirements. The Miss Pennsylvania Belle hereby agrees to indemnify and hold harmless The Miss PA Scholarship Foundation and any other entities which might be construed as liable from and against any and all claims for personal injuries, death, damages, cost and/or other expenses including reasonable attorney’s fees arising from or in any way connected with the use of the premises, and Belle does hereby waive any right of recovery against The Miss PA Scholarship Foundation and any other entities which might be construed as being responsible for loss, damage, theft of such equipment, stock-in-trade, personal property, etc. This agreement is subject to termination by the Miss PA Scholarship Foundation without advance notice or penalty at any time. This agreement is personal to the Miss Pennsylvania Belle and may not be transferred or assigned. It is understood that this agreement is for one year only.

In witness whereof, this agreement has been executed as of the date indicated below.
Belle's Name

First NameLast Name
Parent/Guardian Signature

Clear
For more information about the Miss Pennsylvania Belles, contact Kelly Moyer, Belles Coordinator at misspabelles@gmail.com or 610-468-2145.
Belle's Registration Fee
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Belle's Registration
$300.00 Quantity



Full Size Showcase Page
$300.00 Quantity



Half Page Showcase Page
$150.00 Quantity



Total

$0.00

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