I represent and warrant that I am the parent or legal guardian of the below-named minor child and have full right and authority to submit this information. *

Yes

No

Full Name *

First Name

Last Name

Full Name of Parent or Legal Guardian *

First Name

Last Name

Birthday *

MM

DD

YYYY

Mailing Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

By filling out this form, I grant The Story Seeds Podcast and Literary Safari permission to collect contact information and mailing address of my child(ren) and consent to receiving marketing or promotional emails and postal mail from Story Seeds. *

Yes