Desert Rose Princess Registration
Child's Name for Program Book
*
First Name
Last Name
Child's Date of Birth
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Child's Age
*
Parent/Guardian and Child's Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
1 - Parent/Guardian Name
*
First Name
Last Name
1 - Parent/Guardian - Mobile Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
1 - Parent/Guardian - Email Address
*
example@example.com
2 - Parent/Guardian Name
First Name
Last Name
2 - Parent/Guardian Mobile Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
2 - Parent/Guardian Email
example@example.com
Other Emergency Contact
First Name
Last Name
Emergency Contact - Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Please list three fun facts about your child. (For example, Favorite treat is Skittles, Collects bugs, and Loves plushies.)
*
Has your child previously participated in a pageant Princess program?
*
Yes
No
Please list any food or environmental allergies your child has that we should be aware of.
Please share any medical conditions your child has that we should be aware of.
Please share any special needs your child has that we should be aware of to help us make accommodations.
If you were referred by someone, who were you referred by?
Is there anything else you would like to share with us?
Submit
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