| NETZERO PARENTAL CONSENT FORM
Dear Parent:
NetZero is providing you with this Parental Consent Form because your child has attempted to create an account with us and has indicated that he or she is under the age of 13. In order to comply with the Children's Online Privacy Protection Act, NetZero will not knowingly allow a child under 13 to create an account without parental consent.
Please read the following carefully and follow the instructions below.
1) In order for your child to apply for a NetZero account and use NetZero's Internet access service, it is necessary for us to collect and maintain certain personal information (e.g., name, address, email address) concerning your child.
2) We will use your child's information only as described in our Privacy Policy, which can be viewed at http://www.netzero.net/legal/privacy.html and you can read our special notice to parents of children under the age of 13 at www.netzero.net/legal/special.html. Generally, if you consent, we will use your child's information in the same manner that we use all personally identifiable information except that we will not disclose your child's information to third parties for marketing purposes.
3) If you do not consent, we will not be able to let your child complete the registration process or use the service.
4) You may provide parental consent by following the process below.
PARENTAL CONSENT FORM By completing the following consent process, I consent to have my child register for and use NetZero's Internet access service and consent to NetZero's use of my child's information. I certify that I am at least 18 years old and am the parent or legal guardian of the child who is subscribing to the service.
Please complete the following form and follow the return instructions below.
Name of Child Subscriber:
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| NetZero Member ID of the child:
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| Parent's Signature:
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| Print Parent's Name:
| _________________________________
| Date:
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| Parent's Email Address:
| _________________________________
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RETURN INSTRUCTIONS VIA FAX:
1) Be sure you have read all of the information above.
2) You may fax your consent by printing out this form and filling in all the blanks above and then faxing the form to: (818) 287-3051
REMINDER: YOU MUST RETURN THIS FORM WITHIN 10 DAYS IN ORDER FOR US TO ALLOW YOUR CHILD TO BECOME A SUBSCRIBER TO THE SERVICE. THANK YOU!
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