Child Welfare Record Check Consent Form:

 I,*

Date of Birth:*

 of

*

hereby consent to a search being conducted of the records of Children's Aid Societies in Ontario and the examination and disclosure of any information in the possession of or under the control of a Children's Aid Society in Ontario, regarding myself.

I understand that some Ontario Children's Aid Societies are using CPIN (Child Protection Information Network) as their documentation system. I understand that when an agency using CPIN searches for my record, it will find all records of my involvement with all Ontario Children's Aid Societies also using CPIN. I also understand that documentation regarding this record check will be entered into CPIN.

Previous Places of residence:

I have lived in the following places since I reached the age of 18 years or became a parent, whichever first occurred:

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When completing your request, it is possible that records could be located that match both your name and date of birth but could belong to individuals other than yourself. Finding these alternate records may cause delays in our ability to provide you with timely results in order to confirm your identity. The additional information below is necessary in order to limit the possibility of locating alternative records.

My child/ren's name(s):

*