| 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
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