| Permission to Participate
at Discussion Board
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Instructions for a Parent or Guardian
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The board administrator has not supplied exact instructions for how to mail or fax the COPPA permission form.
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Here is the required information supplied with this registration request:
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| User Name |
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| Password |
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| Email |
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Information supplied below is optional. Please review it carefully. |
Please add any other information you approve to the profile information below. |
| City, State, Country |
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| Occupation |
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| Interests |
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| Homepage |
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| Keep your email address viewable to other users when you post notes? |
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Please sign the form below and send it to us. [see instructions above]
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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.
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Parent/Guardian
Full Name
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Signature
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Relation
to Child
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Telephone
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Email Address
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| Date
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| Online Request Date |
[available for online registration only] |
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Please contact
http://www.exhalefoundation.org/es/patients/about/ with any questions
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