Police Consent to Disclosure Statement

I hereby consent to the collection, use and release of my personal information to verify my identity and to conduct my requested police records check and/or vulnerable sector screening in accordance with the following Notice of Collection:

Notice of Collection:
Personal information is collected subject to your written consent under the authority of sections 6.3(2) and 6.3(3) of the Criminal Records Act, R.S.C. 1985, c.C-47 (as amended), section 2(1)(a) of the Criminal Record Regulations, SOR/2000-303 (as amended), and sections 6, 7 and 8 of the Police Record Checks Reform Act, 2015, S.O. 2015, Chapter 30, and will be used to verify your identity and to conduct your requested police records check and/or vulnerable sector screening. Questions about this collection should be directed to the Manager, Information and Records Services, Halton Regional Police Service, 2485 North Service Road West, Oakville, Ontario, L6M 3H8,Tel: (905) 825-4777 Ext. 4709

I also acknowledge and agree that the following information is deemed by the Police Record Checks Reform Act to be authorized disclosure:

I hereby release and discharge the Halton Regional Police Service Board and all members and employees of the Halton Regional Police Service from any and all actions, claims and demands for damages, loss or injury however arising which may hereafter be sustained by myself as a result of the disclosure of information by the Halton Regional Police Service. I hereby authorize the Halton Regional Police Service to inquire into and disclose the results of any police records to me including: outstanding entries, such as charges, judicial orders, peace bonds, probation and prohibition orders; criminal convictions (summary and indictable); absolute and conditional discharges; family court restraining orders; criminal charges resulting in dispositions including, but not limited to, withdrawn, dismissed, and cases of not criminally responsible by reason of mental disorder; police contacts including but not limited to theft, weapons, sex offences, or violent, harmful and threatening behavior, and to conduct a local police contact search with any police service in Canada.

I further certify that the information provided by me in this application is true and correct to the best of my knowledge and belief.

I have read this Consent, understand it, and agree to it in its entirety.