Consent to communicate with the First Nation

PDF Version (98 Kb, 1 page)

The confirmation of a child's recognition can be provided by the appropriate First Nation official in writing through email, fax, or letter. A template example is as follows:

To be completed by a parent, guardian or child at Age of Consent.

Name of child: __________________________________

I, ______________________________ (name of parent, guardian or child at Age of Consent):

• Understand that the personal information of the child and/or parent/guardian (name, date of birth and family relationship to child) will be used by Indigenous Services Canada to determine whether the child is recognized as a member of the
  ______________________________________ (name of First Nation) in _____________ (province or territory).

I give my consent to Indigenous Services Canada to contact the authorized First Nation official, to confirm recognition of the child for the purposes of Jordan's Principle.

I give my consent to Indigenous Services Canada to share personal information about the child and/or parent/guardian (name, date of birth and family relationship to child) with the appropriate authority of the First Nation to confirm child's recognition.

• I understand that Indigenous Services Canada will only share personal information about the child, parent or guardian (name, date of birth and family relationship to child) with the authorized First Nation official relevant to the process of recognition.
• I understand that personal information is protected under the Privacy Act. I am aware that every individual has a right to access their personal information and that the information may only be used or disclosed as set out in the Act.
• I understand that the personal information collected will be used to assist in facilitating and administering requests made under Jordan's Principle, and if this personal information is not provided, it may result in the department's inability to process the file.
• I understand that I have a right to file a complaint or receive more information regarding the Privacy Act, by consulting the Privacy Commissioner of Canada at 1-800-282-1376.
• I understand I can withdraw my consent at any time by contacting ISC at 1-855-572-4453 or sac.principedejordancan-nccjordansprinciple.isc@canada.ca.
• I have read the above and understand the consent I am providing.

Name (print): __________________________________

Signature: _____________________________________

Date: _________________________________________

Relationship to child: __________________________________