Privacy policy consent form

REGENT CHRISTIAN ACADEMY 15100 – 66A Avenue, Surrey, BC V3S 2A6 Phone: [phone] Fax: [phone] Email: [e-mail] Website: www.regent.bc.ca

January 19, 2016
PERSONAL INFORMATION &

PRIVACY POLICY CONSENT FORM

The purpose of this consent form is to keep student information current and be in accordance with the PERSONAL INFORMATION & PRIVACY POLICY implemented at Regent Christian Academy.

A. Upon acceptance to Regent Christian Academy, I give consent to collect personal information that may include student identification information, birth certificates, legal guardianship, court orders if applicable, parents’ work numbers and email addresses, behavioural, academic and health information, most recent report card, emergency contact name and number, doctor’s name and number, health insurance number and any similar information needed for registration.

B. I further consent to the use and disclosure of information contained in this form and otherwise collected by or on behalf of Regent Christian Academy:
1) for the purpose of establishing, maintaining, and terminating the student’s or parent’s relationship with Regent Christian Academy.
2) for additional purposes identified when or before personal information is

collected, and

3) as otherwise provided in Regent Christian Academy’s PERSONAL

INFORMATION PRIVACY POLICY, a copy of which is available upon request.

C. I also consent to the collection, use and disclosure of such personal information by and to agents, contractors and service providers (eg. Ministry of Education, Public Health Authority etc) of Regent Christian Academy for the purposes listed above.

THIS INFORMATION IS REQUIRED IN ORDER TO REGISTER YOUR CHILD/REN AT THIS SCHOOL AND ASSIST THE SCHOOL AUTHORITY IN MAKING AN INFORMED DECISION AS TO YOUR CHILD/REN’S SUITABILITY AND APPROPRIATE PLACEMENT IN THE SCHOOL. IT WILL ALSO ALLOW THE SCHOOL TO RESPOND IMMEDIATELY TO AN EMERGENCY. FOR MORE INFORMATION, THE PRIVACY OFFICER FOR REGENT CHRISTIAN ACADEMY IS MRS JANICE SAWATZKY AND MAY BE REACHED AT 604.599-8171

PARENT / GUARDIAN SIGNATURE DATE

D. I consent to having photographs and work samples of my child/ren used by Regent Christian Academy in the yearbook, newsletters, web site, and other promotional materal.

PARENT / GUARDIAN SIGNATURE DATE

E. The school may prepare name lists (phone directories, class lists, etc) for the sole purpose of school communication. I consent to having my family name and phone number included on such lists.

PARENT / GUARDIAN SIGNATURE DATE

F. I acknowledge that copies of my vehicle insurance information and driving record are required by the school to protect against third party liability claims in case of an accident, should I use my vehicle to drive to/from activities. I understand that this information will only be related in the event of an accident.

PARENT / GUARDIAN SIGNATURE DATE

RELEASE AND STORAGE OF PARENT PERSONAL INFORMATION Regent Christian Academy acknowledges that there will be no disclosure of personal information to unauthorized personnel or third parties who are not directly involved in school management or the care, supervision and instruction of your child/ren at his school, unless written authorization from a parent or legal guardian is provided to the school. The school will securely store all digital and hard copy parent and student personal information.

PERSONAL INFORMATION PRIVACY POLICY CONSENT FORM Page of