Parent or Guardian Name *

Participant's Name *

Phone *

Email *

Participant's Date of birth *

School / Team *

Allergies, Medications, Special Conditions:

Parent Consent to Participate *

I, the undersigned parent or guardian, do hereby grant permission for my daughter(s)/son(s), whose name(s) is above, and hereinafter shall be referred to as “participant,” to participate in the activities run at Heart of Texas Cheerleading LLC. operating as Heart of Texas Cheerleading and associated events.

DISCLAIMER CLAUSE

Parent or Guardian's Signature *

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