Privacy Policy Form

Please delete my child's personal information and discontinue further use of my child's personal information.
Child's Information
First Name:
Last Name:
Email:

Parent's/Guardian's Information
First Name:
Last Name:
Address:
City:
State:	ZIP:
Email:


I attest to the fact that I am the parent or legal guardian of the above child.

Date (MM/DD/YYYY)	Parent/guardian signature
NOTE: ALL FIELDS MUST BE COMPLETED
or Print, Sign and Fax this form to (678) 348-3599.