Confirmation of Contract Cancellation – over 16 years old

Confirmation of Contract Cancellation (child over 16)

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

– I give notice of cancellation of this contract with CordBank.
– I understand that the cord blood will be discarded and will not be available for use for any purpose should I require it under any circumstances in the future.
– I am over 16 years of age.

"*" indicates required fields

Name*

First

Last

Email*

CK Number*

Your CK Number or registration number from your confirmation email.

Date of Birth*

Contact Phone Number*

Confirmation*

I have read the information below and understand that I am authorising CordBank to destroy my cord blood stem cells.

I  give notice of cancellation of this contract with CordBank.</p>
<p>I understand that the cord blood will be destroyed and will not be available for use for any purpose should I  require it under any circumstances in the future.</p>
<p>I am over the age of 16 and confirm that the cord blood I am requesting to be destroyed is my own.

Confirmation of Contract Cancellation – over 16 years old

Confirmation of Contract Cancellation (child over 16)

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