Verifiable Parental Consent

I hereby certify as follows:

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Name *

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My Child Is... *

I am the parent or legal guardian of: *

My Child's Date Of Birth is: *

If you are a parent or guardian, please check each item below to indicate your consent *

I hereby consent to the collection and use of my child’s personal information as indicated in the Lil' Stevie Adventure Club children’s privacy policy, general privacy policy and terms of use (collectively, the “Terms”). I agree, on behalf of myself personally and my child, to be bound by Terms. I consent to my child’s participation in the Adventures of Lil' Stevie internet site. I hereby consent to communicate electronically with Lil' Stevie (via email) and for my child to communicate electronically with Lil' Stevie without further consent from me.

BY SIGNING BELOW, I CERTIFY THAT I HAVE READ THIS AGREEMENT, THAT I KNOW AND UNDERSTAND THE MEANING AND INTENT OF THIS AGREEMENT AND THAT I AM ENTERING THIS AGREEMENT KNOWINGLY AND VOLUNTARILY. I AM THE PARENT OR GUARDIAN: *

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Email *

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