Consent Update Form

CONSENT UPDATE FORM

Parties

This Consent Update Form and Agreement (the Agreement) is entered into between:

Recitals

WHEREAS, Party A previously obtained certain consent from Party B regarding the processing, use or disclosure of specified information as evidenced by an original consent dated / / ;

WHEREAS, Party A and Party B wish to update, modify, or clarify the scope and terms of that prior consent as set forth in this Agreement to reflect changed circumstances and to provide clear, documented authorization for the continued actions described herein;

NOW, THEREFORE, in consideration of the mutual covenants contained in this Agreement, and other good and valuable consideration, the receipt and sufficiency of which are acknowledged, the Parties agree as follows:

Scope of Consent Update and Scope of Work

Description of the consent being updated (nature of data, actions authorized, limitations, recipients, and duration). If the update applies only to specific categories or purposes, identify them below and provide a detailed description.

Consent Specifics and Selections

Select the categories of consent being updated (check all that apply):

Payment Terms (if consideration is required)

If monetary consideration is required in exchange for the updated consent or services rendered in connection with this update, specify terms below. If no payment is required, enter "No Payment".

Term and Termination

This Consent Update becomes effective on / / and shall remain in effect until / / , unless earlier terminated in accordance with this Agreement.

Either party may terminate this Consent Update for material breach by the other party following written notice and a day cure period, or immediately where required by applicable law.

Confidentiality

Each party shall treat Confidential Information disclosed by the other party as strictly confidential. "Confidential Information" means non-public information disclosed in tangible or intangible form that is designated as confidential or that reasonably should be understood to be confidential given the nature of the information and the circumstances of disclosure. Receiving Party shall not use Confidential Information other than as necessary to perform obligations under this Agreement and shall not disclose such information to any third party except as permitted herein.

Confidentiality obligations do not extend to information that: (a) is or becomes publicly available through no breach of this Agreement; (b) was known by the Receiving Party prior to disclosure; (c) is received from a third party having a lawful right to disclose; or (d) is independently developed without use of the Confidential Information. Where disclosure is compelled by law, the Receiving Party shall provide prompt written notice and cooperate with the Disclosing Party to seek protective measures.

Representations, Warranties and Acknowledgements

Each party represents and warrants that it has full corporate or individual power and authority to enter into and perform this Agreement. Party B specifically represents that the consent provided and updated hereunder is given freely and with full knowledge of the purposes described in the Scope of Consent Update and that the party has authority to grant such consent where applicable.

Governing Law; Dispute Resolution

This Agreement shall be governed by and construed in accordance with the laws of , without regard to conflict of law principles. The Parties shall attempt to resolve disputes in good faith; if unresolved, the Parties consent to the exclusive jurisdiction and venue of the courts located in the governing state unless otherwise agreed in writing.

Indemnification and Liability

Each party agrees to indemnify and hold harmless the other party from and against any third-party claims arising from the indemnifying party's breach of its representations, warranties or obligations under this Agreement. Except for indemnification obligations and willful misconduct, neither party shall be liable for incidental, consequential, punitive or special damages arising out of this Agreement.

Entire Agreement; Amendments

This Agreement constitutes the entire agreement between the Parties with respect to the subject matter hereof and supersedes all prior and contemporaneous agreements, understandings, negotiations and discussions, whether oral or written. Any amendment or modification of this Agreement must be in writing and signed by authorized representatives of both Parties.

Acknowledgement and Certification

By signing below, Party B certifies that they have read and understand the updated consent terms described above, that the consent is given voluntarily, and that they may withdraw or limit the consent only as permitted by this Agreement or applicable law. Party A certifies that it will implement the updated consent as set forth herein.

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