Data Controller:
Address: , State of
Data Subject:
Address: , State of
Personal data. The Data Subject agrees to the collecting, using, storing, and processing of specific personal information (the "Personal Data") that may include but is not limited to the following:
Data processors. The Personal Data will be processed by the Data Controller and .
Purpose of data processing. The Data Subject understands and agrees that the collected Personal Data will be used for (the "Purpose").
Data security and confidentiality. The Data Subject understands and agrees that the Personal Data will be stored securely and accessed only for the Purpose specified above.
Rights of the Data Subject. The Data Subject is entitled to:
Data transferring. The Data Subject understands and agrees to the potential transfer of the Personal Data, for which processing is granted herein, outside the USA. Such transfer shall occur for the purpose of processing subject to an adequate level of protection and appropriate legal safeguards according to the terms of this Consent Form and applicable legislation.
Voluntary participation and withdrawal. Participation in information processing is voluntary, and the Data Subject has the right to withdraw this consent at any time without facing any negative consequences. If the Data Subject decides to withdraw, the Personal Data collected up to that point shall be retained and used in accordance with the terms agreed upon at the time of granting consent.
To facilitate this right, the Data Subject may withdraw consent through the following withdrawal mechanism:
Written notification. The Data Subject can withdraw this consent by providing written notice to the Data Controller. Such notice should be sent to the contact information provided herein and must indicate the withdrawal of consent.
The Data Controller shall promptly acknowledge the receipt of the withdrawal of consent and shall confirm that it has been withdrawn. The withdrawal of consent shall not affect the validity or legality of data processing activities that occurred before the withdrawal. However, it shall result in the cessation of processing the Personal Data.
Governing law. This Consent Form shall be governed by and interpreted under the laws of the State of , and any disputes resulting from or related to this form that cannot be resolved by mutual negotiations shall be exclusively resolved by the courts of the State of .
Contact information. Any questions or concerns about the information processing may be addressed at the Data Controller's contact details specified at the beginning of this Consent Form.
Legal acknowledgment. I have carefully read and understood the information provided above. I have had the opportunity to ask questions and have received satisfactory answers. I voluntarily agree to collect my Personal Data as described in this Consent Form.
Data Subject's name:
Data Subject's signature: ______________________
Date: