In compliance with the Children’s Online Privacy Protection Act (COPPA), parents (or legal guardians) of children under 13 years of age must complete the form. Name First Last Name of Parent/Guardian if under 13 First Last Email Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Pick your incentive Gizmo Book Magnet Black and White Paw Key Ring Orange Paw Zipper Pull/Dog Tag Phone Number of Parent or Guardian if Child is Under Age of 13 Gizmo Magnet(3″ by 2″) Key Chain (1 7/8″ x 2 5/8″) Dog Tag/ Zipper Pull (1-1/4″ x 1-7/8″ x 1/8″)
