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Internet Parental Consent Form
    

 

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Thanks for your support!

 

To the world you make the

difference of only one person.

 

To one person, however,

you can make all the

difference in the world.

 

Thank you for investing in

the lives of others through your

secure online contribution.

 

 

_______________________  

                                                     

The Prosperity Center

Youth Services Division

MISSION: "Youth In Action!"

AAU Basketball Program

Rockingham X-PLOSION

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The Prosperity Center AAU Basketball

Internet Parental Consent Form

The Prosperity Center's Rockingham X-PLOSION Teams Internet Parental Consent Form is both to inform you and to request permission for your child's photo / image and personally identifiable information to be published on our organization's web site.

As you are aware, there are potential concerns associated with the posting of personally identifiable information on a web site since global access to the internet does not allow us to control who may access such information. These concerns have always existed; however, we as an organization that is committed to the successful and prosperous development of our youth would like to celebrate your child and his/her accomplishments.

Pursuant to law, we will not release any personally identifiable information without prior written consent from you as a parent or guardian. Personally identifiable information includes student names, photos or images, residential addresses, e-mail addresses, phone numbers and locations and times of organization trips.

If you, as the parent or guardian, wish to rescind this agreement, you may do so at any time in writing by sending a letter to the Administration Department of the Rockingham County Basketball Club.

Please click on the Microsoft Word Logo link below to obtain a Printable Microsoft Word Version of our Official Internet Parental Consent Form.  No player will be permitted to participate in any activities (practices, scrimmages, games, special events) without turning in a completed and signed Official Internet Parental Consent Form to our administrative staff. Forms received without a valid signature and date will not be accepted.

  Microsoft Word logo

Official Internet Parental Consent Form

(Microsoft Word Version)

Complete this form online and print It!

 

 

Microsoft Word logo

 

Official Internet Parental Consent Form

(Microsoft Word Version)

Print this blank form and complete it by

typing or printing in the requested information!

 

 

 

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