POPA: Father Leonard Van Tighem

Father Leonard Van Tighem: General Media Release POPA Form

The personal information on this form is collected under the authority of Alberta’s Protection of Privacy Act (POPA) (ss. 4(a) & (c)) and will be used solely for the purposes described below.
Student Name

First NameLast Name
Guardian Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Select One

I consent to Southern Alberta Collegiate Institute’s E3 Junior High Program taking photographs and/or video recordings of my child during this event for the purposes of sharing school activities and creating promotional materials. These may appear in print, on our website, or on school-approved social media. I understand this consent is voluntary and can be withdrawn at any time by contacting info@southernalbertacollegiateinstitute.ca, and that withdrawal will apply only to future use.
Signature
Date

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