PSEG Long Island - At Home Safety Sleuth Check

PSEG Long Island - At Home Safety Sleuth Check Thank you for completing the PSEG Long Island Safety Sleuth Home Safety Check. We are excited to hear about what you and your child learned and would love to see your photos. Please share your comments and photos here:

First and Last Name*

Email*

example@example.com

Phone Number*

Child's Name

Here is what we learned (Please add your comments)

Please upload a photo (Optional):

Options for sharing:*

No, please do not sure my photos and comments.Yes, I am happy to share our photos and comments.

If yes, please complete the following statement:

I, the parent or legal guardian of [Child, mentioned above] grant [Party Receiving Permission] my permission to use the photographs described as [Describe Photographs] for any legal use, including but not limited to: publicity, copyright purposes, illustration, advertising, and web content. Furthermore, I understand that no royalty, fee or other compensation shall become payable to me by reason of such use.

Parent/Guardian's Signature for Sharing

Date

Parent/Guardian's Name

Phone Number