Statistics Canada
Symbol of the Government of Canada

Permission to Publish on Statistics Canada’s Internet Site
www.statcan.ca

I, _____________________, give permission for my photograph, picture and/or project to be published on the Statistics Canada Internet site (http://www.statcan.ca). I understand that my last name will not be used with the published photograph, picture or project. This will help ensure my privacy.
Student’s signature:_____________________ Parent’s signature:______________________
Date signed:__________________________ Date signed:__________________________