CONSENT FORM

We, at Smiths Falls District Collegiate Institute, Upper Canada District School Board, are very proud of our students and their achievements. We like to recognize their success in a variety of ways. This may include photos, displays of their work, class photos, special awards, yearbooks and so on. In order to do this, we require and ask for your consent. This consent complies with the provisions of the Municipal Freedom of Information and Protection of Privacy Act and shall be kept on file at the school and will remain valid unless cancelled in writing. Please complete the following information and return it to the school. 1, ______________________________
Parent/Guardian
(please print)

grant

do not grant

Permission to the Upper Canada District School Board to display photographs and/or work of _________________________
Students first name

__________________________
Students surname

along with name, grade and school, in school and Board publications and displays and in articles in the local media.

_______________________
Date

___________________________________
Signature of Parent/Guardian