NOTE: Reference document CD 559 and CD 710-8

PUT AWAY ON FILE Original =Offender VC file

NOTE: Shaded areas are for office use only

Personal information about you is collected under the authority of the Corrections and Conditional Release Act to review your suitability for visiting privileges at the CSC. This information is collected, with no obligation on your part, and held in the Visits and Correspondence Bank; however, your refusal to comply would result in the denial of visiting privileges. This information cannot be disclosed to other persons without your consent EXCEPT where disclosure would be justified pursuant to one of the paragraphs of subsection 8(2) of the Privacy Act.

parent or accompanying adult of the following child/children, absolve the

Correctional Service of Canada from any responsibility it may have in allowing the said child/children to accompany me on a visit to the CSC Institution/facility. For greater certainty, but not so as to restrict the generality of the foregoing terms, I exonerate the Correctional Service of Canada or its servants for any responsibility resulting from an injury sustained by the said child/children while on federal property. I also waive my rights to any claims or actions which I may have against the Correctional Service of Canada or its servants resulting from the admission of the said child/children in a federal institution. Finally, I acknowledge that I am responsible for the following child/children at all times while he/she is in the institution.

CSC/SCC 0653-01E (R-2018-11) (Version Word) (Voir CSC/SCC 0653-1F pour la version française)

Information may be accessible or protected as required under the provisions of the Access to Information Act and the Privacy Act.

Original = Offender VC File Copy = Security Intelligent Officer