I hereby request that the personal information collected by 360 Entertainment, LLC concerning my child be deleted. I understand that this will result in my child being removed from all forums and web pages

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.