To enter - Simply print this form out and fill it in completely

Child's Full Name:

                         

Please Complete this form and mail it with your child's photo, 2 loose stamps and your payment to:

BAREFOOT BABIES Baby Contest™
PO BOX 710
MASSAPEQUA PARK, NY 11762

Parent /Legal Guardian's Name

                         

Address:

                         

City:

                         

Daytime Phone:
   (          )

State:

                         

Evening Phone:

   (          )

Zip:

                         

Email Address:

                        

Child's Age:

  

Child's Gender:

 Male _____     Female _____
Child's Special Talents:  
 
Main Contest - Placement Judging  $20.00 +2 loose stamps for the return of my child's photo
   
TOTAL ENCLOSED
Circle Amount

$20.00    

(Checks should be made payable to: CYBER DEPOT. I understand that if my child wins, I agree to allow the BAREFOOT BABIES BABY CONTEST to publish my child's name, age, state and photo at it's discretion, including promotional literature.
I have Read and understand the contest rules and regulations on the web site.

X______________________________________ ___________

PARENT/LEGAL GUARDIAN'S SIGNATURE

 DATE

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