Captured Moments
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Childrens Furniture Gallery

Contest Entry

Contest Deadline is November 30th! 

You can drop off your entry at any of the following locations:  Cheeky Monkey (either location), Children's Furniture GalleryMama Assist, Kay Chiropractic and Westmount Shopping Centre.  Alternatively you can mail your entry fee to:  PO Box 29118, 785 Wonderland Rd S. London, ON. N6K 4L9.

 

CONTEST DISCLAIMER

 

I certify that I am full age, eighteen (18) years or older and have the right to contract in my own name and on behalf of my child, whose name appears herein. I represent that the child is a minor and that I am the parent or duly authorized representative of the child and that I have read the foregoing and fully understand the contents thereof. This Authorization and Release shall be binding upon me and my heirs, legal representatives, and assigns.

 

I understand that signing this Authorization and Release in no way guarantees publication or approval of the photograph submitted or future photographs which may be taken.

 

Enter Online Now

Full Name
Address
City
Postal Code
E-mail
Phone (Daytime)
Phone (Evening)
Child's Name
GenderMale
Female
Child's Date of Birth (mmm/dd/yy)
We may contact you for future events?Yes
$5.00 Cheque payable to LCRN mailed: Yes
How did you find out about this contest? 103.1 FRESH FM Listener
Friend
News Paper
The Mom On Line-Website
The Mom & Caregiver Magazine
Other-Include Below
Other:
Acknowledge Disclaimer:I have read and agree to abide by the rules outlined in the Contest Disclaimer above
Upload Your Photo Entry:

Captured Moments Photo Contest Entry Form

 

If  you have fantastic photos of your child that you would love to share, please submit your photos using the online form below  or  see the following attachment to submit your entries by mail.

Captured Moments Entry Form


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