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Consent to Collect, Retain and Use Child's Personal Information This form must be filled out by the parent or legal guardian of the child.
It should then be mailed to minortown.com at: I, as the parent/legal guardian of the child(ren) listed below, grant permission for minertown.com to collect, retain, and use the child(ren)'s personal information as noted below. All information collected by minertown.com will be used for internal purposes only, for marketing products, informing of sales and other information, and sales of products. Child(ren) __________________________________________________________ Information allowed to collect, retain and use: Email address(es) listed: _______________________________________________________________ Name(s): ______ Address(es): ______ Telephone Number(s): ______ Other (specify): _______________________________________________________ Signed: _____________________________________________________________
Date _____________ Address of parent/legal guardian __________________________________________ ___________________________________________________________________ Email of parent/legal guardian _____________________________________________ Note: Address and email of parent/legal guardian is only used for record keeping purposes in case of a question regarding parental consent |