Simon Says consent to personal data processing

Dear Sir / Dear Madam

please grant your consent to the processing of personal data by completing and agreeing to the following form:

with the registered address at Ve Střešovičkách 627/13, 169 00 Praha 6, Id. No.: 70546878 (hereinafter the “Agency”), may process, under the terms and conditions specified below and in the sense of the applicable legal regulations, my following personal data (hereinafter the “Personal Data”):

name, surname, birth date, age, gender, ethnicity, appearance, eye colour, hair colour, height, shoe size, body measurements, occupation, skills, languages, telephone number, e-mail, permanent address, temporary address, photo, video recordings, audio recordings, representing agency, account number, and birth identification number.

I acknowledge and agree that my Personal Data may be processed for the purpose of transferring these Personal Data to third parties, in particular to film and advertisement productions, acting and modelling agencies for the purposes of gaining the opportunity to conclude a contract and/or the opportunity to participate in the filming of an audio-visual or similar work, a photoshoot or an event. I agree that the Agency may record and store my Personal Data and transfer them to third parties for the specified purpose and for an indefinite term.

I acknowledge that I may withdraw this consent at any time; I agree that I am giving this consent of my own volition, without being obliged to do so, and only for the purpose of, and in relation with, my activities according to this consent form. I acknowledge and agree that my Personal Data may be transferred abroad, including to countries outside the European Union, specifically to the companies Dropbox, Apple, Google, Wetransfer, Facebook, Vimeo, Youtube, Instagram and Logicworks. Furthermore, I agree that my Personal Data may be transferred to providers of processing software, services and applications for the purpose specified in this consent form, if the Agency intends to use them for this purpose.

I declare that I have been informed that the Agency is obliged to issue, at my written request, a confirmation of whether it still processes the Personal Data or not, and that I may gain access to the Personal Data, including the purpose of their processing, categories of processed data in the list of categories of processed data, including the list of recipients of the Personal Data or persons to whom them Personal Data are disclosed, including transferring the Personal Data abroad, including outside the European Union for the purposes of processing of the data in relation to my business trips and the performance of work or other activities abroad.

I hereby declare that I have been informed of my right to request erasure of my Personal Data, object to the Personal Data processing, and that I also have the right to Personal Data portability, to lodge a complaint with the supervisory authority, to restriction of Personal Data processing in cases specified by legal regulations; furthermore, I have the right to obtain a copy of the processed Personal Data, and I acknowledge that the Personal Data shall not be subject to any decision based exclusively on automated processing, including profiling.

I acknowledge that I may exercise my rights related to my Personal Data through the contact e-mail address at