Name:

Birth Date:

Talent:

BIO:

Name:

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Email Address:

Address:

City: Province:

Postal Code:

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By signing this agreement; I AGREE FOR MY CHILD TO BE PHOTOGRAPH AND OR VIDEO TAPE. I commit myself to payment of the entry fee and my child participating in the upcoming Lil Miss and Mr. Emancipation Pageant. I expressly release Windsor Emancipation Celebration Corp. (WECC), or their agents, as well as the owners of the event sites of and from any and all liability for any damages, injuries or loss which may arise from my child being involved with the Lil Miss and Mr. Emancipation Pageant by any reason thereof.