Little Miss & Mister Firecracker Pageant

Child's Name (required):

Birth Date (required): Age:

Childs Gender?

Resides in the Mt. Morris Fire Protection District?

Parents (required):

Street Address (required):

City / State / Zip (required):

Phone Number (required):

Siblings (list names and ages; required):

Child's Interests
This information will be used for the stage interviews during the pageant judging. Please note anything your child is excited about, examples: recent vacation, new toys, new sibling, pets, etc. (required):

Child's Performance
What will the child perform on stage? Note: Parents must supply any background music if needed and make note of it on this form in order to have the sound system set to play music that night. (required):

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Please submit completed form, then mail your $5 participation fee to: