Permission Form for Children

Dear Parent/Guardian:

When a student participates in an American Heart Association or American Red Cross class, an electronic card or certificate is issued to that student. Due to federal law, we cannot put a child's name into the online databases for either American Heart Association or American Red Cross in order to generate the certification card without your permission.

We encourage children to participate in age-appropriate certification classes. We allow children, with parental consent, to register and participate in certain activities through their schools and communities. We do not collect more information than is necessary to enable children to participate in these activities.

With parental consent, we may collect information from children under the age of 13 such as: name, address, telephone number and email address. That information allows us to issue certification cards, respond to questions about our website and programs, facilitate student participation in activities and other programs and keep records.

We engage third-party service providers to help us develop and operate our website and collection registrations for our classes. Our service providers include Google LLC and JotForm, Inc. If you have questions about the involvement of third parties in providing our services, including their privacy practices, please contact our offices by phone or email.

Regardless of what is submitted, parents can revoke their consent, request that information about their children be hidden or, in some cases, deleted, by contacting us by telephone or via email. When a parent revokes consent, we will stop collecting, using or disclosing information from that child. To comply with such a request, we must verify the identity of the requesting parent. To respect the privacy of parents, we dispose of information that is collected and used solely for obtaining verifiable parental consent or providing notice after a reasonable time after parental consent is declined or revoked.

Our full Privacy Policy, Standards & Statement can be found online at www.aphed.com/privacy

Please agree to the Consent Statement below, provide the required information and sign and submit this form.

Consent*

I give permission for my child's name, address, telephone number and email address to be entered into APHE's and AHA's online databases so my child can receive a certification card.

Name of Student*

Class Date*

Class Location*

Name of Parent or Legal Guardian*

Contact Number*

Area CodePhone Number

Parent or Legal Guardian Signature*

Date Signed*

DateHourMinutesAM/PM Option

Parental Permission Form