Application Form for a German Language Course Personal Details Gender female male First name Surname Language of communication Polish Deutsch English Date of birth Home address Place of birth (city) Place of birth (country) Home address City Postcode Country Contact details Mobile number Email General Terms and Conditions By paying the course fee you agree to the General Terms and Conditions (the GTC are available at the Goethe-Institut Warsaw and online: www.goethe.de/warszawa.) Data Protection Statement By submitting this form, you give us your consent to process your personal data. Our Data Protection Statement is available at the Goethe-Institut Warsaw, on our website: www.goethe.de/warszawa, and on the online platform for students. Declaration of Consent By submitting this form, I consent to the transmission and storage by Goethe-Institut of my personal data (“data”) provided under the terms of my registration and in conjunction with the performance of future agreements to its headquarters in Munich, Germany (“GI-HQ”) and there to combine in its central customer database said data with any other of my personal data previously provided and stored there, if applicable. Furthermore, I consent to the use of my Data by Goethe-Institut and GI-HQ not only for performing the contractual agreement, but also for the purposes of market research, advertising and marketing associated with the range of services offered by Goethe-Institut and, in particular, for providing relevant advertisements or surveys (“Information”), e.g., about new courses offered by Goethe-Institut to me at the contact address I have provided, either by post or – at my special request – also by telephone, fax, email, or text message. Data concerning examinations I have taken may also be transmitted to GI-HQ for storage and use in the central examination archives (for a maximum period of 10 years) for verification purposes and for issuing replacement certificates, as required. To the extent, the Data relates to examinations entitling my foreign spouse to relocate here with me, I hereby authorize GI-HQ to confirm, at the request of the German authorities, the authenticity of a certificate I have submitted to a government agency. Goethe-Institut will not use my Data for any other purpose than those specified in this consent agreement or provide any Data to a third party, unless there is a reasonable suspicion of abuse concerning the Data. I have been informed that I may revoke my permission to use my Data for market research, advertising and marketing purposes at any time. Place, Date YES, I would also like information sent to me by email/text message/telephone. Yes Right of Revocation You may exercise your right to revoke by completing the section below, either now or at some future time: I hereby revoke my permission, effective immediately, for the use of my Data for advertising and marketing purposes. * required When you send us the information contained in the contact form by clicking on the button below, you declare your consent for us to use your personal data for purposes of answering your enquiry and/or contacting you. You can revoke your consent by sending an e-mail message to kurs-warschau@goethe.de. If you revoke your consent, your data will be erased immediately. Otherwise, your data will be erased after we have processed your enquiry or if the purpose of storing it no longer exists. Privacy Policy CancelSend