Consent Form

The Children's Online Privacy Protection Act of 1998 (COPPA) is intended to protect the privacy of children using the Internet. Publication of the rule means that, as of April 21, 2000, web sites must obtain parental consent before collecting, using, or disclosing personal information from children under 13.

If you are a child under 13 who wishes to be on the WBYC mailing list or the parent / guardian of a child under 13 who wishes to add a child to the mailing list, print this form and fill it out in its entirety, have the parent /guardian sign the form and mail it to:

WBYC Mailing List
C/O Lee Alnes
19 Birchwood Road
Mahtomedi, MN 55115

NOTE: Parents can enter their own contact information directly on the mailing list form. WBYC can then contact you directly rather than contact the child.

Childs Information		Parent / Guardian Information
Your Fleet (Cat, C, E, X, etc.):		Name: ______________________________
Your Boat Number:		Address: ____________________________
Your Boat Name:		City/State/Zip: ________________________
Are you a Skipper, Crew or Associate:		Home Phone: ________________________
Your First and Last Name:		E-Mail: _____________________________
Street Address:
City:
State:
Zip Code:
Home Phone:
Cell Phone:
Work Phone:
E-Mail Address:

I certify that I am the parent or legal guardian of the child listed above and I authorize the White Bear Yacht Club Sailing Division to collect, use and disclose the above information regarding the child listed above for the purposes of the WBYC Mailing List. The child's information will be used for WBYC Sailing Division mailings until I request in writing that it be removed.

Parent / Guardian Signature: _____________________________

Date: _____________________________

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