Page 1

Miss Chicago Scholarship Pageant 

Princess Program Application In 2007, The Miss Illinois Pageant started the first ever Miss Illinois Princess Mentoring Program for young ladies ages 5-12. This is the second year for Miss Chicago to host this division at the local level. The purpose of this program is to mentor young ladies who have an interest in competing in the Miss Chicago and Miss Illinois Program. The current Miss Chicago contestants will serve as mentors to the Miss Chicago Princesses! We are thrilled to include your Princess in our mentoring program! In order for the princesses to take part in this production, we request they be present in Chicago for rehearsals (conducted in the morning of February 27th,2010). If you are interested in participating in this program please read each document carefully and submit your packet by the deadline of January 27th, 2010. As we get closer to the event additional information will be emailed to you. Also, please note that the Princess Package includes admission to the Miss Chicago Pageant for the Princess ONLY. Parents and family need to purchase tickets in order to attend. If you have any questions, you may e-mail the Miss Chicago Executive Director, Cara Kokenes Samson at

Our Princesses Receive • • • •

Miss Chicago Princess Tiara Miss Chicago Princess T-shirt/Sash Crowing with Miss Chicago & Miss Chicago Outstanding Teen Goody Bag - Certificate of Excellence

Always check the Miss Chicago website for new information and updates. If for some reason you do not receive any correspondence, information will be posted on the website and you can always use the contact above for questions or concerns.

Miss Chicago Princess Schedule • • • •

Princess Activities/Getting to the other Princesses Interview/Get to know the judging panel—short chat with the official Miss Chicago jugdes, princess will wear provided t-shirt and black shorts/pants (princess will provide this and should be something she can move freely in) On-Stage lifestyle and fitness wear-- Each participant appears briefly on stage modeling sportswear (in character) of her choosing that represents something she does to stay fit On-Stage modeling of evening wear/ankle length princess dress

We look forward to a wonderful experience for your Princess. 


Miss Chicago Scholarship Pageant  Program RULES of CONDUCT 

The Rules of Conduct for Princess are the foundation upon which the images and reputation of the Miss Illinois Princess Program is being built and will continue to be the basis for its operation. Miss Chicago Princesses will conduct themselves at all times with dignity, grace, and good manners of young women who exemplify the integrity of American youth. A Princess must observe all rules and regulations from the time of her arrival in Chicago until her departure. She must register by the official time set and remain through checkout as determined by Pageant Staff. Princesses will not participate in any interview, picture, press contact or any types of publicity unless a member of the Miss Chicago Princess Committee is present. A Princess will not attend parties, meetings, and social events or make any public appearances other than at regularly scheduled events of the Miss Chicago Scholarship Pageant. I HAVE READ THE ABOVE “RULES OF CONDUCT FOR MISS CHICAGO PRINCESS” AND AGREE BY THE SAME. SIGNED: _______________________________________________________________________ Miss Chicago Princess SIGNED: _______________________________________________________________________ Parent/Guardian


Revised 10/27/2009

Miss Chicago Scholarship Pageant 

Princess Program Hold Harmless Agreement

__________________________Having a residence at_______________________ (Miss Chicago Princess Name) (Full Address) ___________________________________________

Acknowledge (by witness of their signature below) her application to participate in the Miss Chicago Princess Mentoring Program, with rehearsals. The Miss Chicago Princess hereby agrees to indemnify and hold harmless the Miss Chicago Scholarship Association, the Pageant Committee and any other entities, which might be construed as liable from and against any and all claims for personal injuries, death, damages, cost and/or other expenses including reasonable attorney’s fees arising from or in any way connected with the use of the premises, and Princess does hereby wave any right of recovery against the Miss Chicago Scholarship Association, the Pageant Committee and any other entities which might be constructed as being responsible for loss, damage, theft of such equipment, stock-in-trade, personal property, etc. This agreement is subject to termination by the Miss Chicago Scholarship Association, without advance notice or penalty at any time. This agreement is personal to the Princess and may not be transferred or assigned. In witness whereof, this agreement has been executed as of the date indicated below. Princess Signature _________________________________________________ Dated this _______ day of __________ 2009 Parent or Guardian’s Signature ____________________________________________ Dated this _______day of ___________2009


Revised 10/27/2009

Miss Chicago Scholarship Pageant 

Princess Program Health Information Form Please Print Name___________________________________________________________ Home Telephone Number:__________________________________________ Parents Telephone Number (Home) __________________________________ Father (Office) __________________ (Cell)_____________________________ Mother (Office) __________________(Cell)_____________________________ Physician’s Name: ________________________________________________ Physician’s Address: ______________________________________________ Physician’s Telephone Number (Office) ________________________________ List Any Allergies: (Medications, Foods, ETC.) ___________________________ _________________________________________________________________


Revised 10/27/2009

Miss Chicago Scholarship Pageant 

Princess Program Checklist

Princess Name _____________________________________________ Age______



Official Application


Registration Fee:

$100.00 – Deadline January 27th, 2010

Cashiers Check or Money Order-ONLY Birth Certificate

Copy Only

Health Form


Rules of Conduct


Hold Harmless Agreement



Head and Shoulders Only for Program Book (no crowns, email photo to Can be same photo as Miss Photogenic below

Miss Photogenic Photo - Optional

$15 entry fee, bio and headshot (emailed to


White, Ankle Length Princess Dress Nylons or White Anklets Princess T-Shirt (provided) Black Shorts/pants (for rehearsals) Snacks

** Other requirements will follow, as we get closer to the event**


Revised 10/27/2009

Miss Chicago Scholarship Pageant 

Princess Program Application   PLEASE PRINT

Name ________________________________________Age____________________________

Mailing Address _______________________________________________________________ Parent/Guardian name(s)________________________________________________________ Email _____________________________________ (all correspondence will be sent via email) Home Phone (_____)___________________

Work Phone (_____)__________________

Cell Phone (____)______________________ T-Shirt Size (please circle) Child Size: S M L

Adult Size: S M L XL

DEADLINE January 27th, 2010 By signing below I acknowledge that I have read and agree to the terms and conditions delineated above; specifically, I understand that my application fee is non-refundable for any reason nor is this application transferable.


Date Please make payments payable to: Miss Chicago Scholarship Association - Princess Program Certified Check or Money Order

Submit Enrollment Fee & Paperwork to: Cara Kokenes Samson, Executive Director PO Box 5171 Bloomington, IL 61702-5171 Email:


Revised 10/27/2009