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.

_________________________________________________________________________________________________________________________

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