I hereby authorize Knospe-Lerncenter GmbH to conduct off-site sessions with the beneficiary at the locations described.
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. If I revoke this authorization, I understand that certain therapeutic activities requiring off-site locations may not be available.
3. Authorization Validity
This authorization will remain in effect indefinitely, unless I request an earlier expiration date here:
Thereafter, this authorization becomes null and void. I understand that I have a right to receive a copy of this authorization.
4. Contact Information for Questions
If you have questions about this authorization or need to revoke it, please contact:
Georgstr 2, 31675 Bückeburg, Deutschland
Phone: +49 5722 9098399
Email: [email protected]
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.
Please be aware that a separate Transportation Release may be required for transport to/from off-site locations or for transport without a therapeutic objective.