BLOOMSBURY USA PARENTAL CONSENT FORM

Please print out this form and mail it to Bloomsbury USA, 175 Fifth Avenue, New York, NY 10011.

I, ________________________________________ (print parent's name), the parent or legal guardian of

_______________________________________(print child's name), have had the opportunity to review the Bloomsbury USA Privacy Policy provided at the Bloomsbury USA Web site (the “Site”). By executing the statement below, I authorize my child to fully participate in the Bloomsbury USA site.

I understand that participation on the Site may enable my child to publicly post personal information (e.g., e-mail address) that will be accessible to others visitors of the Site. I further understand that what other visitors do with this information is beyond the control of Bloomsbury USA.

I also understand that my child's information will be collected and processed in the United States and that the Site uses cookies as described in Bloomsbury USA Privacy Policy. I consent to these practices. I understand that I may withdraw my permission granted herein, with written notice as set forth in the Bloomsbury USA privacy policy, at any time.

I also understand that it is important to provide accurate information in this consent form in case Bloomsbury USA needs to contact me for any reason.

Parent's signature:

________________________________________________________

Dated this __________ day of

__________, 20__________.

PLEASE PRINT LEGIBLY