Parental Consent Form for Use with COPPA Privacy Policy

 

In compliance with the federal Children's On-Line Privacy Protection Act of 1998 (COPPA), parental consent is required before we can collect any information from a child under age 13. Please review our privacy policy here: http://www.eurotard.com/Eurotard Privacy Policy.htm

                      

Parental Approval Required.

 

Your parent or guardian must approve your registration. You will not be able to post until this approval is received. To create your account, please print out this page and follow the directions given below.

 

Login Name (please give alternate names in case your preferred login name is taken): 

_________________________________________________________________________________________________________________________

 

Publicly Displayed Name (the name that will be displayed on the board): 

_________________________________________________________________________________________________________________________

 

E-mail Address (this must be a valid email address. Your password will be mailed to you at this address): 

_________________________________________________________________________________________________________________________

 

State: __________________________________________________________________________________________________________________

 

Birth Date: ____________________________________________________________________________________________________________

 

Yes, I have reviewed the information my child has submitted, and I have read the Privacy Policy for the web site. I understand that the profile information may be changed using the Log in and password for this registration. I understand that I may ask for this registration profile to be removed entirely.

 

Parent/Guardian Full Name: ________________________________________________________________________________________

 

Signature: _____________________________________________________________________________________________________________

 

Relation to Child: ____________________________________________________________________________________________________

 

Telephone Number: _________________________________________________________________________________________________

 

Physical Address: ____________________________________________________________________________________________________

 

Other offline contact method: _______________________________________________________________________________________

 

Parent/Guardian E-mail Address: __________________________________________________________________________________

 

Date: ________________________

 

Please sign and date this form and fax it to us at 770-664-7208 or mail it to us at: pro@eurotard.com.

 

EUROTARD

1328 Union Hill Rd

Alpharetta, GA 30004, USA

Fax: 770-664-7208

© 2011 Tolbert Yilmaz Manufacturing Inc., dba Eurotard. All Rights Reserved.