Teen Chat Participation Waiver
This form is required to provide Conquering CHD(CCHD) with parental/guardian consent for teen to participate in online support chat and to verify age of teen. This must be completed by parent/guardian. Teens must be at least 13 years of age and no more than 17 years to participate.

Conquering may also collect and store the emails of teen participants to share other CCHD events and resources, as well as to contact them regarding any incidents that may occur during the teen chat. Parents/Guardians may suspend communication between CCHD and their teen at anytime.
Email *
Name of Teen with CHD *
Age of Teen with CHD *
Email Address of Teen with CHD *
Do you consent to your teen participating in the Teen Chat? Do you consent to CCHD collecting your teen's email address? *
Name of Parent or Guardian *
Relationship to Teen with CHD *
Initial Below - By entering your initials on the line below, you are effectively providing your signature, indicating that all the information on this form is true and accurate, to the best of your knowledge. *
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