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Parental Consent is Necessary

Since members to New Moon Girls are under 18, they are required to have a parent or guardian fill out a parental consent form. This helps keep the parents informed of anything their daughter is doing on the New Moon Girls Web site.

Dear Parent / Guardian:

Your daughter has expressed interest in participating in New Moon Girl Media’s magazine or online communities by applying to one of our girl boards and/or submitting content to one of our products. We’re so excited that your daughter is interested in sharing her voice with other girls and the world!

Before we can move forward, we need your consent for your daughter’s participation in New Moon activities. To facilitate New Moon’s communication with your daughter, we will ask her to provide her full name, email address, postal address, phone number, age / birth date, and/or her preferred screen-name. New Moon Girl Media stores this information for follow-up communication with your daughter regarding the status of her submission or application. New Moon Girl Media does not share this information with anyone outside of New Moon, nor do we ever post a girl’s identifying information on our web communities. If your daughter’s work or application is accepted by one of New Moon Girl Media’s web communities, we will post it using a screen-name of your daughter’s choosing (we suggest her screen name be other than her first name, and it MUST NOT contain her last name), her age, and her state. New Moon magazine may print a girl’s name, age, city, and state, but never all at the same time (for example, if we print a girl’s last name, we will not print her city). New Moon magazine never prints full addresses or email addresses.

By signing this document, you give New Moon Girl Media permission to collect your daughter’s complete name, age / birth date, address, email address, phone number, and preferred screen name. You also give New Moon the right to retain this information for future use and the right to have ongoing communication with your daughter regarding her current and future submissions, application, and/or future opportunities with New Moon Girl Media. Moreover, you understand that all submissions may be used, edited, and reprinted at New Moon Girl Media’s discretion in any of our products or websites. You daughter retains the copyright to her work except in specific cases where she’s signed an agreement stating otherwise. You understand that New Moon may contact your daughter about participating in PR opportunities if her work is featured in one of New Moon Girl Media’s products. You understand that without your signed consent, your daughter may forfeit opportunities to participate on New Moon Girl Media boards or to have her work published in one of New Moon Girl Media’s products. By signing, you also acknowledge that you have read New Moon Girl Media’s Privacy Policy and that you understand that you may request New Moon Girl Media to remove your daughter’s personal information from our databases at any time, or that you may request discontinuation of communication with your daughter at any time. You also hold New Moon Girl Media harmless for any losses or damages that may occur as a result of your daughter’s participation in New Moon Girl Media activities.

Thank you for supporting your daughter as she uses her voice—we’re so pleased to have her as a part of our community!

Sincerely

Nancy Gruver, New Moon Girl Media Founder

I have read and understand the New Moon Girl Media privacy policy and give New Moon Girl Media the right to store my daughter’s personal information and contacted her as outlined in the policy and in this letter.

________________________________________ _______________________

(Parent’s Signature) (Today’s Date)

________________________________________

(Daughter’s Name & Birthdate)

Please send this form, signed and completed, to

New Moon Girl Media: Consent Forms

2 W. First St. #101

Duluth, MN 55802

Fax it to 218-728-0314, or sign, scan, and email it to girl@newmoongirlmedia.com

Please help your daughter fill in the required information to accompany her submission or application.

Girl’s Full Name: _____________________________________________________________________

Girl’s Birthdate (including year): ____/_____/_________

Girl’s Postal Address: _________________________________________________________________

Girl’s City: __________________________________ State: ________ Zip Code: _________________

Girl’s Phone Number: _________________________________________________________________

Girl’s Email Address: _________________________________________________________________

Parent(s) / Guardian(s) Names: _________________________________________________________

_________________________________________________________

Parent Email Addresses: _______________________________________________________________

_______________________________________________________________

Submission Name (if applicable): ________________________________________________________