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: 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:



1328 Union Hill Rd

Alpharetta, GA 30004, USA

Fax: 770-664-7208

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