TO: _____________________________________ (the "Congregation")
The undersigned hereby consents to the Congregation collecting, using and disclosing the undersigned's personal information, as well as the personal information of any of the undersigned's children who are not old enough to provide their own consent, in the manner described in the Congregation's Privacy Protection Pledge attached hereto, which the undersigned has read and understands.
(name of Congregation member - please print)
(signature of Congregation member)
(date of signature)