Health and Medical Data Consent Form by DataAWARE360

1. Purpose of Data Collection

Your consent allows us to access health data needed to ensure student safety.

2. Types of Data Collected

We may collect the following types of personal data: Medical history, Allergies, Emergency contacts

3. Data Sharing

Your child's personal data may be shared with: Healthcare providers, Emergency services

4. Your Rights

Under the Kenya Data Protection Act, 2019, you have the following rights:

Right to Withdraw Consent: Once granted, you can withdraw your consent at any time by contacting us at [Organization Email] / [Organization Phone] or by following this link.
Right to Access and Rectification: You may request access to or correction of your data.
Right to Erasure: You can request the deletion of your personal data, subject to legal and contractual obligations.
Right to Object: You may object to the processing of your data for specific purposes.
Right to Data Portability: You can request a copy of your data in a commonly used format.

5. Kindly Complete the Form Below

The inputs with a red asterisk(*) are mandatory.

Section 1: General Information

Parent/Guardian Name*

Parent/Guardian National ID No*

Parent/Guardian Phone

Parent/Guardian Email*

Student Name

Student Number*

Medical Conditions*

Retention Period

Your data will be retained for at least 24 months after the last interaction unless otherwise required by law. Once the required retention period by Kenya's Data Protection Act (DPA) ends, your data will be securely deleted or anonymized.

Consent Statement

By checking the consent below, you acknowledge that:

You have read and understood this consent form.
You agree to the collection, use, and sharing of your personal data as described.
You are aware of your rights under the Kenya Data Protection Act, 2019.

View Privacy Policy

Please provide explicit consent to collect this data.

I consent to the collection, use, and sharing of my personal data as described above.

I provide explicit consent for the processing of sensitive personal data where applicable.

I agree to receive marketing communications. I understand I can unsubscribe at any time.

Contact Us

For any queries, concerns, or requests related to your data, please contact us at:

Email: [Organization Email]
Phone: [Organization Phone]

This Data Protection Act (DPA) compliant Consent Form is Powered By DataAWARE360