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Minor Registration
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If you are under 13 years of age and wish to sign up for DailyDiary.com,
you must print out this page, fill out the form and have your parent or
guardian sign it. Then have your parent or guardian fax the form
to 212-833-7680.
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After we receive this form, DailyDiary.com customer service will create your account,
assign you a temporary password, and send you a confirmation E-mail with this password.
At that time you will be able to use DailyDiary.com services.
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All information is used in order to to provide you with personalized content.
As described in our privacy statement,
this information will NEVER be shared or given to anyone without your
permission. It is strictly used to make your experience more interesting and
entertaining.
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Please contact us if you have any questions.
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Name:
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E-mail:
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Nickname:
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Reference:
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Gender (please circle one):
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Male or Female
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ZIP or Postal Code:
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_________________________________________
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Birthday:
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_________________________________________
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Time zone:
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_________________________________________
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Country:
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_________________________________________
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State or Province:
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_________________________________________
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______________________________________________________________________________________
Parent or Guardian Signature
Date
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