Parent Consent Form

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 (Please Print) Parent/Guardian Signature
If the Parent/Guardian consent form is sent electronically the parent/guardian must provide email address for verification.
_____________________________________
Parent/Guardian email address

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Safe Sitter® is a nonprofit, 501 (c)(3) organization.  Copyright © 2008 by Safe Sitter, Inc.  All Rights Reserved.
This page was last updated 01/10/08