COPPA – Children Under 13 Years of Age

Notice to Parents

In compliance with the Children’s Online Privacy Protection Act (COPPA), parents (or legal guardians) of children under the age of 13 must consent to collections, uses, and disclosures of the personal information of their children collected by the GCARC VE Team (referred to as the “Website”). The GCARC VE Team will use any data collected for the purpose of administering an Amateur Radio examination to your child and if successful the information will be submitted to the appropriate Volunteer Examiner Coordinator (VEC) as part of the NCVEC Form 605 application for Amateur Operator/Primary Station license and from there submitted to the FCC. FCC Regulations require that original documents for all license applications be retained for a period of not less than 15 months and information associated with your application may be made public by the FCC.

Any personal information collected will not be used for any other purpose and will only be disclosed to the GCARC Volunteer Examiners administering the exam and to staff of the Volunteer Examiner Coordinator who processes the application, but the GCARC VE Team takes no responsibility for what the FCC does with your child’s personal information once it is sent to the FCC.

COPPA Information Form

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Child's Full Name *

First

Middle

Last

Please enter the child’s full legal name.

Child's Date of Birth (Month, Day, year) *

Please enter the child’s actual and correct date of birth.

By completing and submitting this form to the GCARC VE Team, you certify that you consent to the collection of your child’s personal information as described above.  The entering of your full name on the first line below and on the Signature line constitutes your legal signing of this document.

Your Full Name *

First

Middle

Last

Please enter your full legal name.

Relationship to child *

Please enter a descriptive explanation of your relationship to the subject child.

Your email address *

Please enter your current and valid email address.

Day, Child's of

Your full mailing address *

Address Line 1

Address Line 2

City

— Select state —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

Zip Code

Please enter your full and complete mailing address.

Signature *

Clear Signature

Please sign using the mouse, a light pen, or your finger (touch screens).

Date *

Please enter the date of signature and submission.

Submit

You may revoke your consent at any time to refuse further collection and use of your child’s information, however once your child’s application for Amateur Operator/Primary Station License is submitted FCC regulations require that we retain the original documents, which includes all examination records, for a period of not less than 15 months, and we have no ability to affect how the FCC handles that information.