OFFICIAL REGISTRATION FORM

Applications must be returned to the Fair Office by FRIDAY, June 5th 2020 .

Participant’s Name: ______________________________________________________ __ Permanent Address: ________________________________________________________ City: ___________________________________________ Zip: ______________________ Phone: _________________________________ How long has participant resided in Lassen County? ______________________________ Date of Birth: _____________________________________________________________ Parents’ Names: ___________________________________________________________ Parents’ Phone Number(s): __________________________________________________ Talent to be performed for Stage Arts: _________________________________________ Name of song, if applicable: _________________________________________________ Participant’s Sponsor(s):

1. __________________________________________________________________

Sponsor Contact:___________________________ Phone #: ______ 2. __________________________________________________________________

Sponsor Contact:___________________________ Phone #: ______

Miss Lassen County Scholarship Pageant Participant Profile

Name: _________________________________________________________ Age: ___________________________________________________________ Grade this Fall: __________________________________________________ School this Fall: __________________________________________________ Favorite Subjects: ________________________________________________ My Family: ______________________________________________________ My Pets: ________________________________________________________ Hobbies, Interests, and Favorite Foods: _______________________________ Other interesting things about me: ___________________________________ List the positive qualities of our community and explain how you might enhance its future:

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Miss Lassen County Scholarship Program Scholastic and Community Service Profile

ID #: __________________________________________________________________ Age: __________________________________________________________________ Grade this Fall: __________________________________________________________ School this Fall: _________________________________________________________ Future Goals: __________________________________________________________ Things I do at School:

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Scholastic Awards and Scholarships: ______________________________________________________________________________

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A statement about community service and what it means to me: ______________________________________________________________________________

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Community Service Information:

Activity/Event/Project

Organization

Result/Benefit to the Community

Month & Year

Total Hours

For example: Relay for Life car wash

American Cancer Society

Raised $1000 for our Relay team.

June 2010

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