Data Subject Access Request Form

Please fill in the information below. The website administrator or data protection officer will be notified of your request within 24 hours, and will need an appropriate amount of time to respond.

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Your Name *

What email address do you use to access the above website / app? *

You are submitting this request as

The person, or the parent / guardian of the person, whose name appears above.
An agent authorized by the consumer to make this request on their behalf.

Under the rights of which law are you making this request?

CCPA
GDPR
OTHER

I am submitting a request to ___________

Know what information is being collected from me
Have my information deleted
Opt out of having my data sold to third parties
Opt in to the sale of my personal data
Access my personal information
Fix inaccurate information
Receive a copy of my personal information
Opt out of having my data shared for cross-context behavioral advertising
Limit the use and disclosure of my sensitive personal information
Other (please specify in the comment box below)

Please leave details regarding your action request or question.

I confirm that

Under penalty of perjury, I declare all the above information to be true and accurate.
I understand that the deletion or restriction of my personal data is irreversible and may result in the termination of services with My Great New Website / App.
I understand that I will be required to validate my request by email, and I may be contacted in order to complete the request.