Indian Residential School Commemoration Monuments

Indian Residential School Commemoration Monuments
Consent and Nomination Form

In 2012, Grand Council Treaty #3 unveiled six monuments to honour the children of (both living and deceased) who attended Indian Residential Schools.

We are dedicated to expanding this tribute by adding the names of individuals from the 28 First Nation communities within Treaty #3 who attended Residential Schools. To include an individual’s name on the monument, please complete this consent form, which can be filled out by the individual or an authorized family member on their behalf.
Name to be included on the monument:*

First NameLast Name
Residential School(s) Attended:*
Years Attended (if known):
Name of First Nation / Band Name:*
Clan/Dodem (if known):
Date of Birth:*

MonthDayYear
Date
Email Address*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Is this form being completed by someone other than the individual listed above?*

NoYes
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Email*
example@example.com
Relationship to individual named above:*
Reason for completing on their behalf:*
Acknowledgement*

I understand that by signing and submitting this form, I am giving authorization to Grand Council Treaty #3 to submit my name or the name of my relative for publication purposes for the Treaty #3 Anishinaabe Nation Indian Residential School monuments.
Signature of applicant or authorized relative*

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Date Signed*

MonthDayYear
For further information on the Treaty #3 Anishinaabe Nation Indian Residential School monument, please contact Grand Council Treaty #3 at:

Phone: 1-877-880-5638 (Wiisokotatiwin Department)
https://gct3.ca/people/residential-schools/indian-residential-school-commemoration-monument

Grand Council Treaty #3 understands the importance of confidentiality. Any information provided in this consent form other than the full name of the Indian Residential School student will be kept confidential.

Please note that only those who attended Indian Residential Schools will be commemorated on the monument. Applications received from Day School students will be kept on file for data purposes only.

National Indian Residential School 24-hour Crisis Line: 1-866-925-4419

Crisis Services Canada: 1-833-456-4566 or text 45645

Crisis Response Services for Northwestern Ontario: 1-866-888-8988

Hope for Wellness Helpline: 1-855-242-3310
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