General Data Protection Regulation GDPR Consent and Withdrawal Form | Parental and Explicit Consent | Templates for FCA Authorised and Firms

Hard Copy Consent Form Template

[Insert Organisation Name] takes your privacy seriously and will only process your personal data with your consent and in accordance with the terms stated in our Privacy Notice. If you consent to us collecting and processing your personal data, please sign below: –

Signature:       ______________________                Print Name:    ________________________

Time:               ___________                                      Date:               ___________

I confirm that I have been provided with a copy of [Insert Organisation Name’s] Privacy Notice & Terms & Conditions prior to giving consent ☐

NOTE: Electronic consent, parental consent and consent withdrawal forms used in an electronic format or on a website must have an affirmative action (i.e. unticked box) and you must maintain the affirmative action and evidence such consent, including date and time. You can also use double-opt in method whereby the data subject consents via tick box, then has to follow an email link to make sure that it is the correct person consenting – this double opt-in can also serve as evidence of the consent and must be retained.

Example – I [insert data subject name] consent to you processing my personal data as detailed in your Privacy Notice:  ☐

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Parental Consent Form Template

[Insert Organisation Name] takes the privacy of personal data under our remit very seriously and will only process the personal data of an individual under 13 years of age with parental/legal guardian consent. If you consent to us collecting and processing the personal data of the minor named below, please confirm by signing and dating below: –

I confirm that I am the [parent/legal guardian/representative] of [insert full name of minor] and give my consent for [Insert Organisation Name] to process their personal data in accordance with the terms stated in the accompanying Privacy Notice.

Signature:       ______________________                Print Name:    ________________________

Time:               ___________                                      Date:               ___________

I confirm that I have been provided with a copy of [Insert Organisation Name’s] Privacy Notice & Terms & Conditions prior to giving parental/legal guardian consent ☐

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Parental Consent Withdrawal Template

I confirm that I am the [parent/legal guardian/representative] of [insert full name of minor] and wish to withdraw my consent for [Insert Organisation Name] to process their personal data for any processing activity.

Signature:       ______________________                Print Name:    ________________________

Time:               ___________                                      Date:               ___________

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Explicit Consent Form Template (special category data)

Where we rely on your consent for processing special category data, we will obtain your explicit consent through [a signature/explicit mechanism]. You can modify or withdraw consent at any time, which we will act on immediately, unless there is a legitimate or legal reason for not doing so.

If you consent to us collecting and using your [health/medical]/[insert special category type] for the purposes stated above, please sign below and print your name: –

Signature:   _________________________                     Print Name:    ________________________

Time:             _______________                                         Date:               ____________