The present document is to be returned, completed and signed, as soon as possible, to the address appearing at the bottom of this page. On the one hand it validates the commitment undertaken to comply with obligation in respect of intellectual property rights on accepting our general terms & conditions of sale (http://www.dyseurope.com/en/termsandconditions.html) ; on the other hand it assembles helpful information in guiding your child’s progress.

Confidentiality Agreement

Reception by Dyseurope of the present Confidentiality Agreement determines access to Stages 2 and 3 of the Method ABC and to telephone support
I, the undersigned:
Name
Address
City Postal code Country
Phone : Mobile phone : Fax : E-mail :

hereby declare on my honour that I unequivocally commit myself by the present Confidentiality Agreement
• to use the method abc de Haan & Merlivat exclusively for personal and non-professional means;
• to not use the above-mentioned method for educational purposes, private lessons or in the framework of any given therapy in any circumstances;
• to not transmit any element or component of the method (including possible personalized rules) to any third person;
• to not reproduce or copy all or any part of any document protected by copyright © Dyseurope, Institute de Haan & Merlivat
 

Parent’s profession: father :

 

Signature

 

Parent’s profession: mother :

 

Signature

 
Signed in : Parent’s signature (proceeded by the mention ( « read and approved »)
 
On :  



Confidential Information of the pupil
First name of the child : Age : Boy / Girls
Nationality : Native langage :
Score (from 1 to 10) : verbal capacity : reading capacity: writing capacity :
Class : Average : Litterature : Science :  
Public school? : Internationnal school? : Home schooling? : Special education class? :  
First difficulties Age ? Class ? Class(s) repeated ?
Therapy(s) : yes / no If yes, which type ?
Date when you started : Date when you ended :
Comment:

Privacy agreement:
DYSEUROPE declares to fully respect all confidential and personal information given by the parents and its pupils
DYSEUROPE 52, rue de la République, 80490 Hallencourt - France - RCS 488 556 648
Tél : 00 33 (0)3.22.28.62.87 - methodeabc@dyseurope.com