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Medicine Hat Police Service
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Police Consent to Disclosure Statement

I hereby authorize the Medicine Hat Police Service to conduct a search based on the name(s), date of birth and declared criminal record history, to obtain the information required to complete the police record check and disclose such information to me. This includes a search of the Police Service Records Management System (RMS) and the Canadian Police Information Centre (CPIC) database, maintained by the RCMP. This search of the CPIC database includes a search of the Identification Data Bank (known as the National Repository of Criminal Records), the Investigative Data Bank and the Police Information Portal (PIP).

I hereby release and discharge the Medicine Hat Police Service Board and all members and employees of the Medicine Hat 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 Medicine Hat Police Service. I hereby authorize the Medicine Hat 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, and to conduct a local police contact search with any police service in Canada.

I 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.