No, I do not want my name and address distributed as a member of KACL when requested

Yes, I would like a monthly e-mail detailing news from the Association.

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Signature

Please sign and date.

Dear KACL Members

 Re: Kenora Association for Community Living (KACL)’s Commitment to Member’s Privacy

Our Commitment to Privacy

The Kenora Association for Community Living has a long history of respecting the rights of their members.  We hold personal information about members to help us meet legal requirements and to communicate events or news of interest to the membership. This information can include your name, address, Telephone numbers, email interest in receiving emails which we obtain directly from you in an application completed by you and from time to time adhoc information that would be specified at the time. 

We only collect what we absolutely need

With your consent, we only collect personal information from you for the following purposes:

• To understand your needs and to develop, offer and manage supports and services that meet those needs;
• To meet legal and regulatory requirements.

We do not sell or transfer membership lists. We do not disclose name and address as a member of KACL when requested except as legally required or unless  you expressly consent below to do so..

Got a question? Ask our Privacy Officer

The Privacy Officer is your point of contact if you wish to raise any matters regarding the use of your personal information.

The Privacy Officer is responsible for monitoring information collection and data security, and ensures that other  staff receives appropriate training on privacy issues and their responsibilities under the Code. The Privacy Officer also handles personal information access requests.

Ultimate responsibility for our compliance with the Code, rests, however, with the Board of Directors.

Here is a summary of the 10 Principles of the Code for the Protection of Personal Information. If you would like to receive a complete copy of the Code, please contact us.

1. Accountability We have designated a Privacy Officer who is accountable for our compliance with the principles of the Code.
2. Identifying Purposes Before or at the time we ask you for personal information, we will identify the purposes for which it will be used or disclosed.
3. Consent We require your knowledge and consent for the collection, use, or disclosure of personal information.
4. Limiting Collection The collection of personal information is limited to only the purposes we’ve identified to you.
5. Limiting Use, Disclosure, and Retention We will only use or disclose your personal information with your consent (or as required by law). And we will only retain your information as long as necessary to fulfill identified purposes.
6. Accuracy We will keep your information accurate, complete, and up-to-date.
7. Safeguards We will protect your personal information with appropriate security safeguards.
8. Openness We will make specific, understandable information readily available to you about our personal information policies and practices.
9. Individual Access When you request it, we will give you access to the existence, use, and disclosure of your information. You are entitled to question its accuracy and completeness, and its uses.
10. Challenging Compliance You are entitled to question the Privacy Officer about our compliance with any of these principles.

We need your consent. Here’s how you can provide it

You can provide us with your consent in a variety of ways (depending upon the sensitivity of the information) – in writing, electronically, or verbally in some instances.

The attached consent forms provide you with an opportunity to affirm your consent in writing or to limit the uses and disclosures of your personal information should you choose to do so. You can mail, fax or personally return the attached form.  You can limit or withdraw your consent at any time, subject to legal or contractual obligations. For example, your Association is required by law to provide a record of membership upon completion of the requirements of the Ontario Corporation’s Act.

Kenora Association for Community Living

501 Eighth Avenue South

Kenora, Ontario  P9N 3Z9

Tel: 807-467-5225 Fax: 807-467-5247

www.kacl.ca

For information, questions or concerns on KACL privacy issues, write to:

Privacy Officer

Kenora Association for Community Living

501 Eighth Avenue South

Kenora, Ontario P9N 3Z9

Tel: 807-467-5225 Fax: 807-467-5247

Email: admin@kacl.ca

Sincerely

Dave Lillico, President, Kenora Association for Community Living

Personal Information Consent Form

I hereby authorize the KACL and its affiliates to collect, use or disclose my personal information for the purposes that have been specified as part of this brochure except as indicated below. I acknowledge that these purposes have been identified to me and they include the purposes listed on this accompanying brochure.

Name (please print)_______________________      E-Mail Address ___________________

Telephone Number __________________  Address _______________________________

Date ____________________________ Signature _________________________

Preferred method of contact:  Telephone       Direct Mail           E-mail

It is our preference to obtain your written consent to use information for the purposes described above. However, in the event we do not obtain your consent in writing, we reserve the right to imply your consent for the specified purposes, until such time as you either provide further written consent, or limit or withdraw your consent.

  Yes, I would like my name and address distributed as a member of KACL when requested

 No, I do not want my name and address distributed as a member of KACL when requested

 Yes, I would like a monthly e-mail detailing news from the Association.

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Date                                                                               Signature