RCT*Mart Forums: 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: n/a Mailing Address: RCTmart.com COPPA Compliance c/o Brad Bergman 445 East Bush Street Fort Bragg, CA 95437 |
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 |