Parental/Legal Guardian Consent Form
Please fill out this form, print, sign and fax it to SPC Card™ (905) 850-1740. If you have any
questions, please contact us at firstname.lastname@example.org or (905) 850-0139 in the Toronto area or
toll free at
If parental or legal guardian consent is not received in seven (7) days from submitting this form,
all information pertaining to your registration will be deleted and you will have to re-register.
Why does the SPC Card™ Require Parental/Legal Guardian Consent?
Following Bill C-6, Personal Information Protection and Electronic Documents Act, and per
various children's on-line privacy protection legislation throughout Canada, all children aged
thirteen (13) and under must have parental/legal guardian consent before entering any personal
information, such as their e-mail address, at a web site aimed at their age group. This is to
protect the privacy rights of children.
Your child has expressed an interest in being a member of the SPC Card™ and in order for them
to take advantage of all our features, we require your consent.
Parental/Legal Guardian Consent
I give permission for my child to participate in all activities of the SPC Card™ web site, including
receiving announcements, such as e-mail broadcasts, auction notices, offers and benefits in
addition to participation in contests, sweepstakes and market research studies.
my child's personally identifying information with any third parties and consent, by signature
below to my child's membership in the SPC Card™.
In granting consent:
• I understand that my child may change their profile information by using a password.
• I understand that the SPC Card™ may contact me to verify my consent.
• I may remove my permission, with written notice, at any time.
Child's Registered E-Mail Address:
Parent/Legal Guardian Full Name:
Relationship to Child (e.g., Father, Mother):
Signature: _________________________________________________ Date: ____________