The C.O.P.P.A. Law

This law, passed in 1998 requires any person under the age of 13 to complete this form authorizing Cornerstone Pregnancy Center to make contact with your parent or guardian. Unless you can provide us this required information, we cannot allow you to use our website. Close this page and do not use this website if you do not complete this form.

C.O.P.P. A. Authorization Form

Name:
Email address:
Authorization: (Include your parents name, telephone number and/or email address)

Questions about C.O.P.P.A. Law and this website, please call 214-703-0505.