Police Consent to Disclosure Statement
I hereby release and discharge the Rivers Police Service Board and all members and employees of the Rivers 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 Rivers Police Service. I hereby authorize the Rivers 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discharges; family court restraining orders; criminal charges resulting in dispositions including, but not limited to, withdrawn, dismissed, and cases of not criminally responsible by reason of mental disorder; police contacts including but not limited to theft, weapons, sex offences, or violent, harmful and threatening behavior, 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.
Personal information contained on this form is collected pursuant to the Municipal Freedom of Information and Protection of Privacy Act, s.28(2), s.32(b) and the Police Services Act, s.41 for the purpose of processing this police record check. Questions concerning this collection should be directed to Rivers Police Service, Criminal Records Check Office, 645 2nd Ave., Rivers, (204) 328-7430 or by email.