2017 Foster Children Christmas : Bixby Optimist Club

The Optimist Club of Bixby Request For Financial Support
Date*
MM
DD
YYYY
Student's name:*
First Last
Email:*
Home phone:*
Address:*
Street Address Address Line 2 City State ZIP Code
Date funds are needed by:*
MM
DD
YYYY
Total amount needed:*
Amount requested:*
What the funds are needed for:*
Additional comments:*
Once this form request for financial support from the Bixby Optimist Club has been submitted, it will be reviewed and you will be notified if your request has been approved.

Contestant Name*
Address*
Street Address City State / Province / Region ZIP / Postal Code
Cell Phone
Home Phone
Email*
Parent(s)/Guardian(s):(as you want listed in the program)
Date of Birth*
MM
DD
YYYY
Age:*
High School Grade:*
Hair Color:
Eye Color:
Height
Talent you will be performing at the pageant
List/Describe Your Leadership Roles:
List/Describe Your Volunteer Experience:
Scholastic Honors/Other Accomplishments:
Special Skills or Training: (Examples: Lessons in dance, singing, musical instruments, etc...)
Hobbies:
If you are selected as Miss Bixby, you will be given an opportunity to volunteer for a community organization. What organization would you choose and why?
What qualities do you possess that would make you a good representative of the Bixby Optimist Club and the Pageant?
What one word would you use to describe your personality and why?
Give a brief description of yourself and your family:*
What are you interested in as a future career? What are some of your life goals?

1st, 2nd & 3rd

Awarded to top male, female & youth for 3 mile fun run

$30 Registration
-Includes race t-shirt

$15 Registration
-For 1 mile fun run & walk
-Includes race t-shirt

Race starts at 7:30 AM

Name
First Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone
Email*

Name of Organization*
Contact Persons Name*
Address
City State / Province / Region ZIP / Postal Code
Phone
Email*
Length of Float
Number of People on Float*
Competition Category*
- Commercial
- Church/Civic Group
- Youth Group
- Entry ONLY not party of competition

Name
First Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Parents Name*
First Last
Parents Phone*
Age
Grade
Birthdate*
MM
DD
YYYY
Interests
Email
This field is for validation purposes and should be left unchanged.

Name*
First Last
Age*
Phone*
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Type of Talent*
Phone
This field is for validation purposes and should be left unchanged.