Children'S Online Privacy Protection Act (Coppa) Parental Consent Form printable pdf download

Family, Career and Community Leaders of America, Inc.

Children's Online Privacy Protection Act (COPPA) Parental Consent Form

To comply with COPPA guidelines and for the protection of minors, this form must be completed to

allow minors under 13 years of age to register an account on the Family, Career and Community

Leaders of America, Inc. network. As a registered member, your child will have access to provide

membership roster data including name, age, e-mail addresses, phone numbers, gender, ethnicity,

race, grade level and t-shirt size. This information, which may be shared with state associations and

local chapters, is used to help students complete applications for awards and recognition, create

participation portfolios, deliver the FCCLA magazine to students and notify students and their parents

and/or guardians of opportunities supportive of the educational mission and objectives of FCCLA.

You may verify your consent of your child’s registration and use of the site in accordance with our

I represent and warrant that the information provided below is true and accurate and is provided for

the purpose of consenting to my child’s registration with the FCCLA Network.

Membership Details

(Please print all information except for signature.)

Student First Name: ____________________________Date of Birth _____________

Student Last Name: ____________________________________________________

School or Chapter Name: _____________________________ Chapter ID _____________

Adviser First and Last Name: ____________________________________________________

Adviser Email Address: ____________________________________________________

Parent/Guardian Details

Information provided is for parental consent only and will not be shared with unaffiliated third parties

per our privacy policy.

Parent’s/Guardian’s Full Name: ____________________________________________________

Parent’s/Guardian’s Phone Number: ____________________________________________________

Parent’s/Guardian’s Email Address: ____________________________________________________

Parent’s/Guardian’s Signature: _____________________________ Date: _________________

National FCCLA

Please return this form to the local FCCLA adviser who will then

submit it to the National FCCLA Organization.

Your privacy is important to us.

Until this form is submitted to National FCCLA, students under the age of 13 will not be

entered into the membership system, nor allowed to provide any data to the FCCLA Network.

For more information about the Children's Online Privacy Protection Act (COPPA), visit

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Children'S Online Privacy Protection Act (Coppa) Parental Consent Form