Cheerleader/Mascot Name *

Grade Level *

Monogram *

Food Allergies *

Parent #1 Name *

Parent #1 Email *

Parent #1 Phone Number *

Parent #2 Name

Parent #2 Email

Parent #2 Phone Number

Parental/Guardian Photo Release Form- We (Samuel Clemens Cheer Booster) are sending you this parental consent form to request permission to use your child’s photo/image and name for Samuel Clemens Cheer Booster advertising purposes to include social and other media. This release will be valid until the cheerleader/mascot is no longer a member of the Samuel Clemens cheer team. *