1. Form 180-1.1 Amended: 2013-08-27


Form 180-1.1 Amended: 2013-08-27


September 2013

 
 

CONSENT TO DISCLOSE PERSONAL INFORMATION
 

 
As per Section 7 of the FOIP regulation, consent is requested for situations no statutory provisions exist to allow the Division to disclose an individual’s personal information. The consent is voluntary and may be revoked at any time by contacting in writing the FOIP coordinator for the Division.
 
By signing this form, the employee consent for the following instances:

 

·   Photographs, videotapes or interviews taken by the Division where material will be used outside the school system, such as Division owned websites and social media pages, where the employee named below is identified

·   Photographs, videotapes or interviews taken by the media or any other organization/individual previously approved by the Division where the employee named below is identified

                
Consent period: September 1, 20_____ to the last day employed with the Holy Family Catholic Regional Division No. 37
Employee name: ____________________________________________________
Employee Signature: _________________________________________________
 
 
If you have any questions or concerns regarding the collection of this information and the intended purpose, please contact the Principal at your school, or the FOIP Coordinator for Holy Family Catholic Regional Division #37, 10307-99 Street, Peace River, AB, T8S 1K1 Phone: 780-624-3956

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