Childs Email Address: _____________________________________________
Parents Email address: ____________________________________________
Under the law, we are obligated to verify the identity of the requestor
of this information and to ensure that the requestor is in fact the childs
parent or legal guardian. To help us discharge this responsibility, please
fill out the following:
Please state your relationship to the child: _____________________________
Please state your name: ___________________________________________
Signature: _______________________________________________________
Date: ___________________________________________________________
Please print and send this form to: Privacy Coordinator, Kid Chess™, 2501
E. Piedmont Road, Suite 160, Marietta, GA 30062. Alternatively you may fax it to
603-590-7534.