PARENT/GUARDIAN INFORMATION ACCESS FORM
Sally Ride Science Club™
Please use the following form to access information collected at "www.SallyRideClub.com" about your daughter (as a parent or legal guardian of your child). Please check any or all of the options below:
__ I wish to review the personal information currently collected on my child at www.SallyRideClub.com.
• I wish to correct factual errors in my child’s information.
__ I request that all personal information currently collected on my child at www.SallyRideClub.com be deleted.
__ I request that, in the future, personal information regarding my child no longer be collected or maintained by www.SallyRideClub.com
To help us identify your child in our database, please fill out the following:
Child’s Email Address: ____________________________________________
Child’s User Name: ______________________________________________
Parent’s Email address: ____________________________________________
Under the law, we are obligated to verify the identity of the requester of this information and to ensure that the requester is in fact the child’s parent or legal guardian. To help us fulfill this responsibility, please fill out the following:
What is your relationship to the child: _________________________________
What is your name: _______________________________________________
Security Answer: _________________________________________________
Signature: _______________________________________________________
Date: ___________________________________________________________
Please print and send this form to: Privacy Coordinator, Sally Ride Science Club, 9191 Towne Centre Drive, Suite L101, San Diego, CA 92122.
Alternatively you may fax it to 858.638.1419.