WNY Gamers Club:
COPPA
Permission Form
Instructions for a parent or guardian:
Please print this form out, complete it and mail to the mailing address below.
Please (click here) for an Adobe Acrobat version
suitable for printing. Forms will also be available at the event, but a Parent /
Legal Guardian must be present at the time of signing. Sample form and mailing
address is below:
Mailing Address:
WNY Gamers Club
151 Ames Ave
Tonawanda NY 14150
Please sign the form below and send to us.
I understand that my son/daughter will be playing games at Lan Party
Extravaganza with possible rating "M for Mature".
Name of Child
______________________________________________________________
Parent / Legal Guardian FULL name
______________________________________________________________
Relation to child
______________________________________________________________
Signature
______________________________________________________________
Email Address
______________________________________________________________
Phone Number
______________________________________________________________
Date
______________________________________________________________
Registration Now Open!
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Payment Options
*** Vendors or Sponorship requests contact us @
for more info on sponsoring this event ***
*** Volunteers contact us @
for info on Volunteering for the next event (setup or take down) ***
