Celtic Radio Community: 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.
Att: Paul MacArthur
24 Central Street
Braintree, MA 02184
|Choose a Member Name
3 - 32 letters and/or numbers only.
|Choose a Password
Passwords must be between 3 and 32 characters long.
|Your email address
You will need to enter a real 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|