Parental Consent Form

REQUEST FOR PARENTAL CONSENT FOR COLLECTION OF PERSONAL INFORMATION CONCERNING CHILDREN


Click here to get the pdf version

Dear Parent:

PostandCourier.com is the Internet website for The Post and Courier. We have been contacted by a child who has stated that (s)he is under 13 years old and wishes to participate in the following activity available on or through the Site:

__________________________________________________________________________[parent, please fill in the activity in which your child wishes to participate].


The child seeks to participate in this activity from the following email address:

______________________________________________________[parent, please enter the email address].

Since certain personal information about your child, such as name, email address, postal mailing address, phone number and/or credit card information may be required for this activity (see the registration form and terms of the activity, as set forth on the Site); we are contacting you for your permission to collect and/or maintain personal information from your child.

A copy of our website Privacy Statement is attached. It includes discussions of what information we collect, how we collect it, and to whom we disclose it. It also discusses how to change or delete information previously collected and how to prevent further collection or disclosure. The Privacy Statement can also be found by clicking on Privacy Statement.

Please print a copy of this consent form. If you permit the child to participate in the activity listed above; you agree that the child is bound by the Terms of Use of the Site and any terms, rules or agreements associated with the activity (see the Site for further details); and you permit us to collect and maintain personal information from your child, please write your initials here: _________________. Without your permission, your child may not participate in the activity.

You may consent to the collection of personal information from your child without consenting to the disclosure of such information to third parties (subject to certain exceptions, such as in the case of legal actions and for purposes of operating the activity see Privacy Statement for details.) If you consent to the disclosure of the child's information to third parties, please write your initials here: ____________________.

Please sign and date this consent form below, and return it by email or postal mail to:

Parental Privacy Consent
c/o Administrator
Evening Post Industries
134 Columbus Street
Charleston, SC 29403

Ph: (843) 577-7111
Email: development@eveningpostinteractive.com

The operator in charge of privacy issues, may be reached at the address above for any questions related to this form.


CONSENT:

I ___________________________ [printed name of parent] am the parent or legal guardian of ___________________________ [name of child whose information is at issue], and I hereby agree to the terms initialed above, signed ___________________________ [signature of parent].

Dated: _________________ in the city of ____________________, state of _______________, country of ______________________.