Pretty Smart Cookies · Consent Form

This form covers program participation consent, photo and media permissions, virtual session guidelines, and liability acknowledgment. Your typed name in each section serves as your legal signature.

Participant Information

Tell us about your daughter.

Participant Full Name *

Date of Birth *

Age *

City, State, Country *

Parent & Guardian Information

How do we reach you?

Parent/Guardian Full Name *

Relationship to Participant *

Email Address *

Phone Number *

Is there anything Miss Mika should know before her first session? This stays private. It just helps us show up for her better.

Section 1

Program Participation Consent

Signature — Type Full Name *

Date *

Section 2

Photo & Media Release

During PSC programming, photos, video, and audio may be captured by PSC leadership for documentation, promotional materials, social media, website content, and reporting. By default, participation in PSC constitutes consent to be photographed and filmed. If you'd like to opt out, indicate below and contact us through our contact page before your daughter's first session.

I would like to opt out of photo and media capture. I will follow up via the contact page to confirm.

Signature — Type Full Name *

Date *

Section 3

Virtual Guidelines & Liability

Signature — Type Full Name *

Date *

Almost done ♡

Communication Preferences

I'd like to receive PSC updates, session reminders, and program news. PSC may email my daughter directly for Zoom links and session materials.

By submitting, you confirm all information is accurate and your typed name in each section serves as your legal signature. This form is valid for one program year.

Thank you, Cookie Mom. ♡

We received your form and we are so glad she is here.
Her seat is ready. We will see her soon.

Questions? Reach us here.

Consent & Release Form.

Thank you, Cookie Mom. ♡