Contract cancellation form

In order to formally end the contract, and for security purposes, you need to provide the following information.

Name*
First Last
Email*
CK Number*

Your CK Number or registration number from your confirmation email.
Name of Child*
First Last
Child's Date of Birth*
Contact Phone Number*
Confirmation*
- I have read the information below and understand that I am authorising CordBank to destroy my child's cord blood stem cells immediately.
Terms of Service
I give notice of cancellation of this contract with CordBank. I understand that the cord blood will be destroyed and will not be available for use for any purpose should I or my child require it under any circumstances in the future. I am the legal guardian(s) of the child whose blood is stored by CordBank under this contract. My child is under 16 years of age.

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