Data Subject Access Request Form

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 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.

Data Subject Access Request Form

Your Name

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

You are submitting this request as

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

Please leave details regarding your action request or question.

I confirm that