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Safe Sitter® adheres to the guidelines created by the Children's Online Privacy Protection Act of 1998. The Internet offers a world of opportunity for children. Your guidance and involvement are essential to help ensure that children have a safe and rewarding online experience. Your efforts to instill responsible information practices will help steer your children to age-appropriate sites, and will go a long way toward ensuring that your children have enriching online experiences.

Instructions: To give your child permission to participate, please review, print, and complete the information below. The completed form should be faxed to 317-545-SAFE (7233), transmitted electronically or mailed to:

Safe Sitter, Inc.

8604 Allisonville Road, Suite 248

Indianapolis, IN 46250-1597

If you have any questions or concerns, please contact us by email at safesitter@safesitter.org

I, , (parent or guardian's name) hereby certify that I am the parent and/or lawful guardian of child's name.

I understand and agree that when my child registers with www.safesitter.org to participate in surveys, www.safesitter.org may collect and maintain certain personal information about my child, including:

First and last name
Gender
Birth date
If they are a Safe Sitter® graduate and where they took the course
Opinions requested in the survey

I understand that the above information will not be disclosed to third parties. I have read and reviewed the Parent/Guardian Consent Form and the www.safesitter.org Privacy Policy, and I give my permission for www.safesitter.org to collect and use personal information about my child in accordance with the above terms.

Parent/Guardian Name

If the Parent/Guardian consent form is sent electronically the parent/guardian must provide an email address for verification.

Parent/Guardian email address