LFCDG Ambassador Consent & Information Release

Please fill out the below form, or you can download and print the form and mail it to us. Download PDF.

Please enable JavaScript in your browser to complete this form.

As a Lions Foundation of Canada Dog Guides (LFCDG) Ambassador, your role includes working with Lions Foundation of Canada (LFC) Chairs and other Lions to support communication, awareness, and engagement with Dog Guides across Canada.

To help introduce our Ambassadors and support communication between Ambassadors and LFC Chairs, LFCDG is requesting your consent for the following uses of your information.

Public Announcement

I give Lions Foundation of Canada Dog Guides permission to publish my:

· Name

· Lions District

· LFCDG Ambassador role

This information may be included in LFCDG communications, including the Bark & Roar newsletter, to introduce and recognize LFCDG Ambassadors.

Please select one:

I consent to the public use of my name, district, and Ambassador role as described above.
I do not consent to the public use of this information.

Contact Information Sharing

I give Lions Foundation of Canada Dog Guides permission to share my:

· Name

· Lions District

· Email address

with current Lions Foundation of Canada Chairs for the purpose of facilitating communication and collaboration related to LFCDG activities, initiatives, presentations, outreach, and Lions engagement.

This contact information is intended for LFCDG/Lions Foundation-related purposes and is not intended for public distribution.

Consent

I consent to LFCDG sharing my contact information with LFC Chairs as described above.

I understand how my information will be used and shared as outlined above. I understand that I may contact Lions Foundation of Canada Dog Guides if I wish to update or withdraw my consent for future use.

Name

First

Last

Email Please Consent

Date