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COPPA Agreement


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Dear Parent/Guardian:

This Consent Form and Release (“Release”) is made by ___________________________________________ (“me or “I”, the Parent/Guardian) and LEAD, a Non-profit Organization (“LEAD”), located at 270 E. Westminster Ave., Suite 200, Lake Forest, IL 60045. This Release relates to minors signing up and using LEAD’s websites and applications, including but not limited to Text-A-Tip, Bloom Student, and/or any other technology products or programs created by LEAD.

In compliance with the Children’s Online Privacy Protection Act (COPPA) regulations,, any child under age 13 must have parental consent for the collection, use, or disclosure of that child’s personal information by a website.

LEAD’s Bloom Student web application allows your child’s school to create an account for your child, and enables educators and administrators at your child’s school to track and understand emotional and mental health information collected during your child’s use of the Bloom Student progressive web application. Children record emotions and other mental health indicators throughout the day. As part of this service, LEAD collects personal information from its users that may include name, email address, age, school of attendance and grade level, in addition to any of the content your child records during the use of the Bloom Student application. For information on LEAD’s use and collection of personal information, please review LEAD’s Privacy Policies at and

In consideration of the opportunity accorded to my child to use the Bloom Student web application, I hereby state and agree that I consent to the collection, use, and disclosure of my child’s personal information as described here, and in the LEAD Privacy Policy, when an account has been established and/or used for and by my child on the Bloom Student web application. Parents may access their child’s personal information to review or delete the information at any time. By signing below, you consent to the collection and use of your child’s personal information by LEAD and the disclosure of your child’s personal information to their school. LEAD will never sell, rent or otherwise distribute your child’s personal information.

I am the parent or guardian of the minor/s named below. I have the legal right to consent to and do consent to the terms and conditions of this Release.

Parent Signature: __________________________________

Printed Name: __________________________________

Date: ____________