not attached, you are assuring Virtualology that you have read the policy and
did not want to forward the whole document.
Evisum, Inc., PO BOX 441, Bridgeville, PA, 15017
policy may be found at our website at
PO BOX 441, Bridgeville, PA, 15017
I HEREBY UNCONDITIONALLY GRANT
MY PERMISSION AND CONSENT TO YOU TO COLLECT AND TRANSFER TO THIRD PARTIES
(EDITING SPONSORS, JUDGES, ETC... SEE USES
OF INFORMATION COLLECTED
MY CHILD’S PERSONALLY IDENTIFIABLE INFORMATION AND CLASS WORK WHICH HE OR SHE MAY PROVIDE TO
YOU FOR THE PURPOSE OF REVIEW, EDITING AND POSSIBLE PUBLICATION AT
AND ITS AFFILIATED INTERNET SITES. I HEREBY STATE AND AFFIRM THAT
I AM THE LEGAL GUARDIAN OR PARENT OF THIS CHILD AND THAT I AM OVER THE AGE OF 18
I HEREBY UNCONDITIONALLY GRANT MY PERMISSION AND CONSENT TO
THE unlimited publication (in total or
edited) and broadcast,
use, FOR THE incorporation into
websites, or other
mediums, of any submissions and
that they may be used in any current or future advances in the state of
communication that may be developed for virtualology publication and/or broadcasting.
understand that I may revoke this consent by going to
Revocation Form, and printing the Revocation of Parental Consent
Form, completing and signing it, and mailing it back to:
PO BOX 441
Bridgeville, PA, 15017
understand that I may chose to have my child’s first name omitted from publication
web site by prominently stating this on my child’s
submission next to their name.I
understand that if an actual name is not used, a screen name including city,
state, class name, class category (primary, secondary, college or some level in school) and school
identifier must be provided.
I understand that it is
Policy not Publish or Broadcast any
minor student's last name on any
following required information will be used for verification purposes and to
issue the submission code.
screen name (No last names): _________________
Note: The mailed version may not be as current as the web site version
I understand that the privacy
policy may change from time to time. The most current form can be found at the
website or by requesting a copy through the mail. I understand that my child can
not register with the site and participate in the activities of the site where
personally identifying information is collected unless and until I sign, date,
complete and return this form to you.
A copy of the Parental Consent
Form will be Emailed to the parent/guardian (if under 18 years old) and in all
cases, e-mailed to the teacher with the Submission Code for that particular
child.This may take several weeks to process.
understand that by signing my name above I am giving permission for personally
identifiable information about my child to be collected and transferred.I understand that the form I am signing was obtained from
Inc..This form may have been provided to me by my child, but I am assuring you
that the signature below is my own legal signature, that I am over the age of 18
years and that I am the legal guardian or parent of this child and reside in the
immediate household of this child.
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