Please review and complete the information below. Sign your name at the bottom of the form and fax it to Lake Wylie Pilot at (803) 628-0300. When Lake Wylie Pilot receives and processes your consent form, we will activate your child's account. I, __________________________, hereby certify that I am the parent and/or lawful guardian of ____________________________. My child's Account Identity is _______________________________. I understand and agree than when my child registers with Lake Wylie Pilot to use its services or participate in its surveys, contests or games, Lake Wylie Pilot, or its authorized agents, may collect and maintain certain personal information about my child, including: First and last name Gender Parent's email address Birthdate Telephone number I also understand and agree that if my child registers with Lake Wylie Pilot to win a prize, Lake Wylie Pilot, or its authorized agents, may collect my child's shipping address in addition to the above-described information. I further understand and agree that the above-described information will not be disclosed to third parties unless Lake Wylie Pilot has a good faith belief that it is reasonably necessary to comply with the law or to protect the interests of Lake Wylie Pilot, The McClatchy Company or others; except that such information may be provided to authorized third parties for the purposes of providing the services available on the Lake Wylie Pilot site or of awarding prizes. I have read and reviewed the above and the Lake Wylie Pilot Privacy Policy and I give my permission for Lake Wylie Pilot to collect, use and disclose personal information about my child in accordance with the terms stated therein.   ___________________________________________ Parent's Signature ___________________________________________ Date