Parental Consent Form

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Parental Consent Form

Please fill out this "Parental Consent Form" if you are 13 years of age or under and submit it WITHOUT filling out the "Empower Expression Sign Up Form."

After you fill this out, we will email your parent/guardian and verify that you are permitted to provide us the information asked for in the section below. If they consent, we will notify you to fill out the "Empower Expression Sign up Form."

Sign in to Google to save your progress. Learn more

First Name

Your answer

Last Name

Your answer

Your Email

Your answer

Parent/Legal Guardian's First and Last Name

Your answer

Parent/Legal Guardian Email

Your answer

Submit

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy