CA SBC Consent Form Photos

							                                                            CA - Sprott Business Competition
                                                            Ontario Student Contact Information
                                                            Collection Form



Full Legal Name: ________________________ / __________ / ________________________________________
                        (First)             (Middle Initial)           (Last)

Age at most recent birthday: ________ (years)    Grade: _________

School: _________________________________________ Municipality: _________________________________

E-mail: _____________________________________________________________________________________

I authorize the Sprott School of Business to use photographs, video or audio of me captured at the CA-SBC
Competition finals held at Carleton University or The Woodlands School on May 6th 2011 for the purpose of
publicizing and promoting the CA-SBC Competition. I hereby grant a non-exclusive license to the Sprott School of
Business for the use of this information for an indefinite term; however, I may rescind this license by writing to the
contact named below. The license is restricted to the usage described in this consent document.

Signature:        _____________________________________________________________

Date:    ________________________________________

Under Ontario’s Freedom of Information and Protection of Privacy Act (FIPPA) any right or power conferred on an
individual under the Act may be exercised by a person who has lawful custody of the individual where the individual is
less than sixteen years of age. Contestants under sixteen years of age must obtain the consent of a parent or legal
guardian in order to provide their contact information.

Parent/Guardian Name (Please print): _____________________________________________________________

Relationship to Student:               _____________________________________________________________

Signature:                             _____________________________________________________________

Date:                                  ________________________________________



 The personal information requested on this form is collected in accordance with Sections 38(2) and 41(1)
 of the Freedom of Information and Protection of Privacy Act (FIPPA), R.S.O. 1990, c.F.31 as
 amended. The information provided will not be used for any purposes other than those stated here without
 your express permission. Should you have any questions concerning your personal information please contact
 Virginia Taylor, Administrative Officer and FIPPA Representative for the Sprott School of Business, 710 Dunton
 Tower, Carleton University 1125 Colonel By Dr., Ottawa, ON K1S 5B6, phone (613)520-3532. Carleton
 University is fully compliant with FIPPA and endeavors at all times to treat your personal information in
 accordance with this law. Please see the SBC Privacy Policy for more information about how Sprott cares for
 your personal information: http://sprottbusinesscompetition.ca/SBC/aboutus/privacy.aspx