Withdrawal form

 

If you want to cancel the contract, please fill out this form

and send it back.

At

School-on-Schwalbenweg

Gisbert Knierim

Schwalbenweg 19

44625 Herne

I / we hereby revoke the consent given by me / us

the publication of visual / acoustic media on which our / our

 

 

 

Date, …………… .. Place: ………………………….

 

 

 

……………………………………….

 

 

and

address

………………………..

………………………..

………………………..

………………………..

 

 

 

……………………………………………. ………………………………………………….

Signature / s of legal guardian