|
Parental Consent Form
I hereby grant my permission for girlsrcool.com to contact and correspond with my child and to include my child on their mailing list.
Signature of Parent/Guardian:_______________________________________________________
Print Name of Parent/Guardian:______________________________________________________
Date Signed:____________________________________________________________________
Name of Child:___________________________________________________________________
Age of Child:____________________________________________________________________
Parent/Guardian Contact Information:
Email Address:__________________________________________________________________
Postal Address:__________________________________________________________________
City:_________________________State:____________________ Zip Code:_________________
Daytime telephone #:___________________________Evening telephone #:___________________
Child's Contact Information:
Email Address:__________________________________________________________________
If you want your child to receive any girlsrcool.com mailings or free t-shirt offer, please provide the following information:
Postal Address:__________________________________________________________________
City:___________________________ State:____________ Zip Code:_______________________
t-shirt size: (circle one)
Child- small, medium, large
Adult- small medium large
Note: If this consent form is for more than one child, please list the names, ages, email information of the other children for whom you are granting permission:_____________________________________________________________________
Fax or Mail this form to:
Girlsrcool.com
Attention: Sandra Vernon, President
28 Ridge Road
Lebanon, New Jersey 08833
Fax: 908-832-1543
Email: info@girlsrcool.com
|
