Alberta Rhythmic Sportive Gymnastics Federation, Operating As Rhythmic Gymnastics Alberta

Alberta Rhythmic Sportive Gymnastics Federation, Operating as Rhythmic Gymnastics Alberta (RGA)

PERSONAL INFORMATION PROTECTION AND ELECTRONIC DOCUMENTS ACT

2008-2009 STATUTORY DECLARATION

I, ______, having the necessary authority to bind the ______(RGA Member Club) do solemnly declare as follows:

1.______(RGA Member Club) is in compliance with the Personal Information Protection and Electronic Documents Act (PIPEDA) and/or substantial similar provincial privacy legislation.

2.______(RGA Member Club) has obtained written consent from its Members (Club Members) for the collection, use, and disclosure of personal information to Rhythmic Gymnastics Albertafor the following purposes:

1. Receiving information and communications from Rhythmic Gymnastics Alberta in order to provide the members with the programs, services, products and information required as a member of Rhythmic Gymnastics Alberta including newsletters, e-mail bulletins, donation requests, invoices, notification of future programs, activities, fundraising and merchandise sales;
2. Establishment and management of trust funds and distribution of honorariums;
3. Processing merchandise orders, registration, and travel administration;
4. Athlete registration, outfitting uniforms, monitoring eligibility and team selection;
5. In the case of medical emergencies;
6. Media relations and media publications; and
7. Publishing sports information and images of athletes and participants.

3.______(RGA Member Club) will retain this written consent for the 2008-2009 membership year.

4.______(RGA Member Club) will indemnify, release, hold harmless and forever discharge Rhythmic Gymnastics Alberta, and its directors, officers, employees, volunteers and representatives for any claims, actions or costs that may arise out of, or in relation to, the collection, use or disclosure of personal information which was disclosed by ______(RGA Member Club) to Rhythmic Gymnastics Alberta and others. Such indemnification will include any amount paid by Rhythmic Gymnastics Alberta with respect to liability and any and all legal fees and disbursements incurred by Rhythmic Gymnastics Alberta.

AND I make this solemn declaration, having the necessary authority to bind______(RGA Member Club), conscientiously believing it to be true and knowing that it is of the same force and effect as if made under oath and by virtue of the Canada Evidence Act.

Name: ______(Please print)

Club Name:______

Position: ______

Signature: ______

Date: ______