Required fields are marked with asterisks (*)

Release of Information Consent Form

I provide permission for the Town of Stony Plain to make available for viewing on the Town of Stony Plain website, my provided telephone number and pet name(s), when that pet's tag number is searched through the Pet Tag application.

This personal information is being collected for municipal operations under the authority of Section 33c of the Freedom of Information and Protection of Privacy (FOIP) Act and will be used in the administration of Lost Pet Registry within the Town of Stony Plain. The personal information provided will be protected in accordance with Part 2 of the Act. If you have any questions regarding the collection, use, and disclosure of personal information, please contact the FOIP coordinator at 780-963-2151.

First Name:

Last Name:

Contact telephone number to be released on website:

Address:

Pet Name(s):

Please sign here.

Clear

Date: