I hereby consent to 360 Entertainment, LLC collection, use, and/or disclosure of information about my child through the use and registration process online at all sites owned and/or operated by 360 Entertainment, LLC.

I have read and understand 360 Entertainment, LLC Information Practices with Regard to Children.

I understand my right to review and have deleted my child's personal information, and my right to refuse to permit further collection or use of my child's information by sending written notice, in the form attached, to 360 Entertainment, LLC.

I understand that this would result in my child being dropped from any registrations or registrations currently in progress at the time of such notice.

Child's Name (print)
______________________________________________

______________________________________________
Parent Signature                                                                Date

Parent's Printed Name:
 _____________________________________________

Parent's Address:
 _____________________________________________

City/State/Zip Code:
______________________________________________

Phone: (_____) ______-_________

FORMS RETURNED WITHOUT ADDRESS AND PHONE NUMBER WILL NOT BE ACCEPTED AS VALID CONSENT.