I, _________________, am the parent or legal guardian of ________________ ("Child"), a child under the age of 13. I understand that I am authorizing the Child to have full access to CrossDaily.com and the products and services it provides ("Service"). I understand that the Child will be sent an email newsletter and have access to various commercial products including advertising links to sites located outside and not under the control of Salem.

I have read the Salem Privacy Policy and Terms of Use and hereby consent and agree to the terms and conditions contained therein. I also understand that the Service may provide links to other Web sites and Services not under the direct control of Salem, and that it may not always be clear to me or my Child when we leave the Salem Web site to receive content from another Web site or provider. As a result I agree that Salem will not be liable for any damages incurred by the Child, either directly or indirectly, from the use of the Service.

I recognize that I can remove the personal information of the Child from any and all customer lists maintained by Salem.

Name [print]: ______________________

Phone number: _________________________

Address:
_________________________
_________________________
_________________________

Current email address: _________________________
Social Security number: ________________________
Drivers License number: _____________________ State: ________

Signature: _______________________________

Date: _________