PERMISSION FORM

For consideration given, I hereby authorize the use of my child’s picture about divorce to be posted on the Divorce & Kids web site.

Check one of the following:

( ) I do not want my child’s name to be used.

( ) You have my permission to use my child’s name by the picture.

Child's Name ____________________________

Permission is granted by: ____________________________

Relationship to child: ____________________________

Address: ____________________________

City, State, Zip: ____________________________

Phone Number: ____________________________

Print Out This Form and Mail It With The Picture(s)