HomeMy WebLinkAboutConsent to Release Personal InformationCONSENT TO RELEASE PERSONAL INFORMATION
Municipal Freedom of Information and Protection of Privacy Act, 1990
Personal information on a Nomination or Registration form is collected under the authority of the Municipal
Elections Act, 1996 and will be used to assist the City Clerk in the administration of the 2022Municipal
Election. Questions regarding this collection should be forwarded to election@kitchener.ca.
Indicate if you are a candidate or a third party advertiser:
Candidate for the office of:
Mayor
Councillor, Ward # _______
Waterloo Region District School Board
Waterloo Catholic District School Board
Conseil scolaire catholique MonAvenir
Third Party Advertiser
Name of Candidate or Third Party Advertiser: ________________________________________________
In addition to the information provided on the Nomination/Registration form, you are permitted to submit one
website URL to be displayed on the City of Kitchenercandidate and third party advertiser webpage.
Website URL: ____________________________________________________________________
You may also email election@kitchener.ca with your URL
Please indicate below the information you would like included on the City of Kitchener candidate and third
party advertiser webpage(s), acknowledging the Nomination or Registration form filed by you is available for
public inspection at City Hall.
Address Phone Number Email Address
The City will not check for any changes to the information provided as it is the responsibility of the candidate or
third party advertiser to advise the City of any changes.
I acknowledge thepersonal information I identified which is contained within the Nomination Paper (Form 1)
or Notice of Registration - Third Party (Form 7) filed by me, will be disclosedto the general public.
Signature of Candidate/Third Party Advertiser
X
OFFICE USE ONLY:
Dated at the City of Kitchener
(municipality)
of Region of Waterloo
(county, district or regional municipality)
This ___________ day of _______________ . 20 ________.
day month year
________________________________________________________
Signature of City Clerk or Designate
Schedule 31e