I hereby request that the personal information collected by Xanga.com concerning my child be deleted. I understand that this will result in my child’s account being shutdown.
Child’s Full Name (print):
_______________________________________________________________
Child’s Xanga Username (mandatory for successful shutdown):
_______________________________________________________________
Child’s Birthday:
_______________________________________________________________
Parent’s Full Name (print):
_______________________________________________________________
Parent’s Relationship to Child:
_______________________________________________________________
Parent’s Address
_______________________________________________________________
_______________________________________________________________
Daytime Telephone:
_______________________________________________________________
Evening Telephone:
_______________________________________________________________
Email:
_______________________________________________________________
ACKNOWLEDGMENT AND REPRESENTATIONS
In signing this Parental Request form, I hereby acknowledge and represent that I
(a) am over 18 years of age and of sound mind;
(b) am the parent or legal guardian of the child named above.
Parent Signature:
_______________________________________________________________
Date:
_______________________________________________________________
FORMS RETURNED WITHOUT ADDRESS AND PHONE NUMBER WILL NOT BE ACCEPTED
Please print and complete the form above. Then, mail or fax the completed form to the contact information below. Xanga will respond within two business days:
Xanga.com, Inc.
Attn: Parental Deletion
112 W. 34th Street, 18th Floor
NY, NY 10120
or fax to : (917) 591-9200