Consent Form to Disclose Personal Information

To the extent that the foregoing information constitutes personal information as defined by the Municipal Freedom of Information and Protection of Privacy Act, R.S.O. 1990, Chapter M.56, as amended, the information is subject to provisions of that Act and will be used to permit information to be shared with another person appointed by you using this form. Questions about the collection of personal information should be directed to our Clerk’s Department, Village of Oil Springs, 4591 Oil Springs Line, Oil Springs, ON, 519-834-2939.Please note that this consent is valid until it is revoked in writing.

I, being the individual to whom the personal information relates,

, of

do hereby give permission to an authorized staff person of the Township of Warwick to disclose my personal information to the third party listed below.


Third Party Authorized to Receive the Personal Information:

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