MICHAELSCHILLING.com Forum: COPPA Permission Form Instructions for a parent or guardian Please print this form out, complete it and fax it to the number specified (if present) or mail to the mailing address below. Fax Number: Mailing Address:

Enter your desired log in username
Enter your Email Address

Please sign the form below and send to us. I understand that the information that the child has supplied is correct. I understand that the profile information may be changed by entering a password and I understand that I may ask for this registration profile to be removed.

Parent / Legal Guardian FULL name
Relation to child
Signature
Email Address
Phone Number
Date