|MHE and Me
Parental Consent Form
|I give permission to MHE and Me to publish a web page for my child. I understand that information for the page is to be provided by my child and myself. My child understands that he or she will be sharing his or her story or poetry with other people and is comfortable with that. It is up to you and your child whether you would like a photo or photos to appear on the page.
I understand that no last names, addresses, or phone numbers will appear on my child's page, and that MHE and Me has the right to edit my child's story, poem, or other submission as appropriate and/or necessary.
I understand that my child and I will have the opportunity to review the Web page before it is published to the MHE and Me Web Site, and will have an opportunity to request changes, additions, or deletions at that time. I may request additional changes to my child's page at any time, by emailed request to email@example.com.
( ) Please post my child's email address on his/her page. That email address is:
( ) Please DO NOT post my child's email address on his/her page. Instead, please post a notice that anyone wishing to contact my child may do so c/o MHE and Me, and that any messages received for my child will then be forwarded by MHE and Me to us.
I understand that I may contact MHE and Me and ask to have my child's email address either deleted from or added to the web page, by emailed request to firstname.lastname@example.org
( ) I am submitting my child's story/poem for creation of a web page on the MHE and Me Web Site.
( ) I will be forwarding my child's story/poem separately, by email
Present Grade in School:_______________________
Telephone Number: _______________________________________
Email address for parent/guardian:___________________________________________
Favorite colors (for Web page design):________________________________________
( ) My child would like to have a pen pal(s).
Signature of Parent or Guardian
Please mail the completed form to:
MHE and Me
PO Box 651
14 Stony Brook Drive
Pine Island, NY 10969