CITRONELLE JUNIOR WOMAN'S CLUB
2005 Beautiful Baby Contest - benefits March of Dimes 
ENTRY/CONSENT & RELEASE FORM

  Baby's Name: _________________________________________________

Guardian's Name:________________________________________________

 Address: ____________________________________  City: ____________________

 State: _____  Zip Code: ___________ Phone #’s: _____________________________

  Baby's Date of Birth (newborn - 36 months): _____________Male or Female______________

 I hereby give permission for my child's photo & name to be used in all aspects of CJWC's "Beautiful Baby Contest".  I will provide a NON-COPYRIGHTED photo if my child wins.  I also agree not to call the Call News or the Marketplace for results of the contest.
 
 Signature: ________________________________________________________

  You may mail this form, along with $5 and a 5x7 (or smaller) photo with child's name & telephone # on the back, to:

 CJWC

 P.O. Box 172

  Citronelle, AL 36522