Producer Consent Form

for the Disclosure of Information Pertaining to

Poultry Disease Incidents

This is a consent for disclosure of information about the investigation of a

federally reportable disease of poultry.

1. The Producer who is giving consent. This consent is given by the individual
or entity who is the subject of the disease investigation (the "Producer").

Legal name of the Producer: Silver creek colony

Business operating name (if different from above): Silver creek colony
(the "Operation")

If the Producer is not an individual, then the person who is authorized to sign this consent on
behalf of the Producer is: Larry hofer

2. This consent is given to: The Canadian Food Inspection Agency (CFIA)

3. Recipient of lnformation. In this Producer Consent Form, "Recipient" means

one or more of the following marketing boards (as the CFIA considers to be appropriate
for the case at hand): Alberta Hatching Egg Producers, Egg Farmers of Alberta, Alberta
Chicken Producers, and Alberta Turkey Producers.

4. Consent. The Producer agrees:

(1) CFIA may disclose the Information to the Recipient so that they may
use and disclose it for the purposes listed below;

(2) CFIA may make the disclosures to the Recipient starting from the date of
the Producer's signature and ending 90 days after;

• EXCEPTION: If there is a quarantine order at the time of the

Producer's signature, or if one is made within 90 days after the
Producer's signature, then the disclosure period ends with the
quarantine period.

(3) The Recipient may use and disclose the Information starting from the date
of receipt from CFIA and ending 30 days after.

Revised April 2022

Classification: Protected A
 • EXCEPTION: If there is a quarantine order, then the use period
ends with the quarantine period.

5. Purpose. CFIA may disclose the Information to the Recipient so that they may
use and disclose it for the following purposes:

• To be informed about new incidents of poultry-related disease in

Alberta; and

• To notify poultry producers who are members of the marketing

board(s) and the poultry-related industries (e.g. transporters,
suppliers, buyers, egg graders), to take measures to protect
property, animals, people, and the environment.

6. Information. In this Producer Consent Form, "Information" means the

following information from a CFIA investigation of poultry disease. (NOTE: If the
Producer wishes to remove some items from the list, they should cross out the item and
initial the change.)

1. Name of the disease

2. Nature of the disease situation

3. Address of Operation

4. Legal Land Description of Operation

5. Name of Operation

6. Name of Producer
7. Whether the Producer is a quota member, and if so, of what Board(s)
8. Type of operation, e.g., hatchery, table egg producer, etc.
9. Type(s) of avian species at the Operation
10. Number of birds at the Operation and/or maximum bird capacity of the Operation
11. Status of the investigation, including updates on actions taken
12. Control measures recommended or enforced
13. Status of control measures

Note: The Producer understands that this Producer Consent does not restrict CFIA's authority
under the Health of Animals Act to collect, use, and disclose information. That Act continues
to apply. Subject to the Act and Freedom of Information and Protection of Privacy Act, CFIA
will discuss details of the disease investigation with others if it is necessary for ensuring a
proper disease response.

Revised April 2022

Classification: Protected A
 Agreed by the Producer:

Authorized signature: Larry

Print name:

Title: _Silver creek colony _

Date: April 11, 2022

____________________________________

Revised April 2022

Classification: Protected A