Zodiac Girlz - Parental Consent Form

PARENT'S CONSENT FORM FOR CHILD'S REGISTRATION

Name of Child

Child's E-mail Address

Child's Age

Parent's Name

Parent's E-mail Address

Parent's Street Address

Please check one in each of the following listed statements:

1. I have reviewed and understand your online privacy policy which is posted at www.zodiacgirlz.com/privacy.html

       Yes         No

2. I consent to your collection, use and maintenance of personal information about my child.

       Yes         No

3. I consent to your disclosing personal information about my child to third parties as described in your privacy policy.

       Yes         No

Signature        Date

Please fax COPPA forms to: 818-459-7019