Chat-Web Parental Verifiable Consent Form

Date: ____________

By completing this form, you agree to give permission for your son/daughter who is currently under 13 years of age to access the children's chat rooms and public forums in the Chat-Web Network.  Your child will require to be registered to chat on the Chat-Web Network, once this form is processed, and signed by a parent or guardian over 18, they will be allowed to begin chatting at Chat-Web.

You also understand that your child has the ability to potentially post personally identifiable information about themselves. You also agree to have read the Chat-Web privacy policy located at http://www.chat-web.com/privacypolicy.html 

Upon completion

I certify that I am at least 18 years old and am the parent or legal guardian of the child named above. I understand that if this document is found to be incorrect, Chat-Web reserves the right to terminate my or my child's membership without notice.

Name:_____________    Signature: ___________   Email Address (if you would like to recieve a reply email) :___________ 

Childs Chat Nickname:__________________

Please Print and Mail this form to:

S.Hastings
PMB #312
138 Court STREET
Brooklyn, NY 11201


Please Note:  This information will NOT be shared with any third party.  Please email webmaster@chat-web.com  with any concerns or questions.