Privacy – Personal Information Consent Form

Contact Form

The purpose of this form is to cover privacy issues protecting both you and Champlain Park Community Association’s – Communications Committee.

We need to obtain your consent on what personal information we are allowed to make public via our communication channels. (i.e. website, flyer and posters)

Please complete Part 1 and Part 2 of the following web form.

Part 1 – Personal Identification

This information you provide is used strictly to identify who you are and will not be made public.

Part 2 – Personal Consent

By completing this information you are giving your consent to the Champlain Park Community Associations – Communications Committee allowing them to use this, your personal information publicly on the various communication channels supported by this Committee. (i.e. website, flyer and posters)

None of your personal information will be sold to any third-party or shared outside of Champlain Park without your permission.

Updating – Personal information

Please also use this form anytime to provide any changes/updates to your consent, by re-submitting. Please indicate this using the Additional comments.

PART 1 – Personal identification








PART 2 – Personal CONSENT

Please complete only the fields below which you give consent to be made public.

(A usage example:  Partial or all information provided below maybe posted on websites Contact page)