Consent For Collection of Child's Information From Parent
For
Collection of Child's Information and for Child's Participation in Interactive
Activities in which the Child May Disclose Information.
If you agree to provide
consent for the limited collection of information about your child
as provided for above, and for your child's participation in the
interactive activities corresponding to the boxes you check below,
please sign below and send this form to us via mail to:
Virgo Birthday Headquarters,
to verify your consent.
Please check the appropriate box (es) below to indicate which activities on the
website your child may participate in:
[ _ ] Story Submissions: By checking on this box, you consent
to your child's participation in the Virgo Birthday story submission activity,
in which your child may submit a story to Virgo Birthday for posting on the website
for others to read. Your child's story will be accompanied by your child's first
name and state of residence.
[ _ ] Contests/Games & Drawings: By checking on this box,
you consent to your child's participation in online contests and games that require
personally identifiable information to play. Some contests may include prizes
in which winning contestants' names are entered into a random-selection drawing
for free prizes. Winner's first name and state of residence will be displayed
online.
[ _ ] Chat Room: By checking this box, you consent
to your child's participation in the Virgo Birthday chat room, in which
your child may post information for others to read and respond to.
We encourage your child to use an alias when using the chat room, but
cannot control what information your child decides to provide in the
chat room.
[ _ ] Gift Registry: By checking this box, you consent
to your child’s participation in the Virgo Birthday Gift Registry
in which your child may list her favorite Virgo Birthday products.
Only individuals who are provided with an access code by you or your
child will have access to the gift list.
I, __________________, the parent or legal guardian of __________________ give
permission for Virgo Birthday to collect and use information about my child as
provided for above, and for my child to participate in any of the following activities
for which I have checked the corresponding box above. I also understand that
Virgo Birthday has no control over the content of submission made pursuant to
your child’s participation in the Chat rooms or story/games/contest/drawing
submissions. If my child uses the Chat Room or submits stories, drawings or contest
submissions to Virgo Birthday, my child may post his/her e-mail address or other
personally identifiable information, within the body of the submission, that
other website visitors may be able to view. I understand that my child may lose
access to the Virgo Birthday Chat Room, or any other online activities, if he/she
violates the rules or behaves inappropriately. Virgo Birthday also reserves the
right to disallow access to the site, in its sole discretion, for any reason
that it deems appropriate.
[ _ ] By checking this box I confirm I have read page all policies, privacy policy,
under age 13 privacy policy, website useage agreement and agree to the terms
of service on this date and usage agreements for my child under age 13.
Parent's signature:_____________________________
Date Signed:________________________
Note: The staff at Virgo Birthday, Inc. works hard to ensure that this site is
safe. If you have any questions about our registration procedure, monitoring
policies or to suggest improvements, feel free to write us.
This policy was last updated on 03/19/2005. Page 2 of 2.
Page [1]
NOTICE: Visit http://www.ftc.gov/privacy
for Information from the Federal Trade Commission about protecting children's
privacy online.
Please review our Privacy Statement/Children's
Statement, which provides additional information regarding
Virgo Birthday's privacy policies. [1]
Parent or Guardian: In order to provide your consent, please print out this form,
fill it out, and mail it to:
Unfortunately, no submissions can be accepted by e-mail! If
you are having trouble printing out this form please email or write us and we
will send you a printed form or a Acrobat .pdf file to print.
You may also contact us, at the fax number or address provided above, to review
your child's personal information at any time, or to request to have any personal
information about your child deleted. You may also contact us in this manner
at any time to withdraw your consent, or to refuse to allow any further participation
by your child in any of the website activities. We will need you to provide us
with your password to access your child's information.
Please register by providing the information below:
Virgo Birthday User Information:
Parent's e-mail address:_________________________
Child's e-mail address:__________________________
Parent’s Address: _____________________________
__________________________________________
Child's name:________________________________
Gender: ____________________________________
Parent's name: _______________________________
Parent's Phone Number: ________________________
(Note: Will be used only if there is a
problem with the registration.)
Virgo Birthday User Names
Please provide your choices of a user name and password for your child. Please
be sure to use a made-up user name. This helps to protect your child's identity.
Please give us three different choices, in case someone has already picked one
of your names. This is very important since we will be creating the user names
for you. All user names must be at least three characters long and contain no
spaces or symbols. If all of the names you have chosen are taken we will create
a variation of the first choice.
Note: your password can not contain spaces or symbols, i.e.,
!@#%^&*() ' "? / < >..etc. It needs to be between 8 and 15 characters
in length and is "case sensitive" and only uses alphanumeric characters
from a-z, 0-9.
*image dimmed to prevent web robots from automatically harvesting
information.
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