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Permission to Participate at Discussion Board

Instructions for a Parent or Guardian

The board administrator has not supplied exact instructions for how to mail or fax the COPPA permission form.
 
 
 
 
 
 

Here is the required information supplied with this registration request:

User Name
Password
Email

Information supplied below is optional. Please review it carefully.

Please add any other information you approve to the profile information below.

City, State, Country
Occupation
Interests
Homepage
Keep your email address viewable to other users when you post notes?
   

Please sign the form below and send it to us. [see instructions above]

YES: I have reviewed the information my child has supplied and I have read the Privacy Policy for the web site. I understand that the profile information may be changed by using a password. I understand that I may ask for this registration profile be removed entirely.

Parent/Guardian Full Name



Signature



Relation to Child



Telephone



Email Address



Date

Online Request Date [available for online registration only]

Please contact http://www.exhalefoundation.org/es/patients/about/ with any questions

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