Media Release

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BENEFICIARY INFORMATION

Beneficiary Name
Legal Representative (if applicable)

MEDIA RELEASE

1. Authorization

I hereby authorize Knospe-Lerncenter GmbH to use my media in the forms and for the purposes described below.

2. Purpose and Media Forms for Release

Coordinating care with authorized individuals (recommended)
Internal professional trainings
External professional trainings
Marketing including social media

3. Right to Revoke

I understand that I have the right to revoke this authorization at any time by providing written notice to Knospe-Lerncenter GmbH. Revocation will not affect any actions taken before the receipt of the revocation.

4. Statement of Consequences

I understand that once my media is disclosed, it could be shared publicly, including on the internet and social media platforms. I am aware that I will not receive compensation for the use of my media.

5. Authorization Validity

This authorization replaces and supersedes all previous medical release forms to the beneficiary. By signing this form, I acknowledge that any prior permissions or restrictions I may have set are null and void.

This authorization will remain in effect indefinitely, unless I request an earlier expiration date here:

Optional Expiration Date

Thereafter, this authorization becomes null and void. I understand that I have a right to receive a copy of this authorization.

6. Contact Information for Questions

If you have questions about this authorization or need to revoke it, please contact:

Knospe-Lerncenter GmbH
Georgstr 2, 31675 Bückeburg, Deutschland
Phone: +49 5722 9098399
Email: [email protected]

7. Acknowledgment

I have read and understood this authorization form. I understand that I have a right to receive a copy of this authorization.

By signing below, I agree to the terms and conditions outlined above.

Team Portal

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