Ethnos360 - Opt Out Form

Ethnos360 MK Care Program

Opt Out Form
*Please submit one form per child
Name of Child*

First NameLast Name
Child's Birthdate*

MonthDayYear
Parent Name*

First NameLast Name
Parents E-mail*
example_example@ntm.org
Opt out details*

Remove this child from the MK Care ProgramKeep in program, but limit contact to parents only
Any other questions or comments
Should be Empty: