>>>                Kids Online Parental Consent Form                <<<


I _______________________ certify that I am the parent or legal guardian

of _______________________. He or she has my complete permission to use

all areas of Kids Online. I understand that I can delete my child's

account at anytime. I also understand that I cannot hold Kids Online

or Mike Barnard responsible for the actions of my child or any other

child using their services.



User Information - (Please do not leave anything blank)


Child's first and last name: ___________________________________________.

Child's Kids Club username: ____________________________________________.

Parent or legal guardians first and last name: _________________________.

Child's age: _____.

Today's date: _______________.

Parent's or legal guardians' email: ____________________________________.

Parent's or legal guardians' signature: ________________________________.


Note: This form MUST be filled out completely by hand and not typed.


Send completed form to:

Kids Online Kids Club
6351 Panther Creek Road
Talbott, Tennessee, U.S.A.
37877


Please allow one week after receiving form for account to be activated.

An email will be sent once activation is complete.

Please make sure entire form is printed out and filled in before sending.

Thank you, Mike Barnard - Founder of Kids Online - www.kids-online.net