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Consent Statement

Consent Statement Template for Canada

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Key Requirements PROMPT example:

Consent Statement

"I need a Consent Statement for my medical research facility in Ontario, compliant with PIPEDA and PHIPA, to obtain permission from participants for a clinical trial starting in March 2025, including consent for collecting health data and sharing anonymized results with international research partners."

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Document background
The Consent Statement is a crucial document required under Canadian privacy law, particularly PIPEDA and provincial privacy legislation, for organizations collecting, using, or disclosing personal information. This document serves as a formal record of informed consent and is essential for demonstrating compliance with Canadian privacy regulations. The Consent Statement must be used whenever an organization collects personal information from individuals, whether for business operations, service delivery, or other purposes. It should clearly articulate the scope of consent, specific uses of information, security measures, and the individual's rights. The document must be written in clear, accessible language and should be regularly reviewed and updated to reflect changes in data handling practices or legal requirements. This Consent Statement template is designed to be customizable while maintaining compliance with both federal and provincial privacy requirements.
Suggested Sections

1. Introduction and Identity: Identifies the organization seeking consent and the individual giving consent

2. Purpose of Collection: Clearly states why personal information is being collected and how it will be used

3. Information Being Collected: Detailed list of what personal information will be collected

4. Use and Disclosure: Explains how the information will be used and any third parties it may be shared with

5. Storage and Security: Describes how the information will be stored and protected

6. Duration and Withdrawal: Specifies how long the consent remains valid and how to withdraw consent

7. Declaration and Signature: Formal statement of consent and space for signature/date

Optional Sections

1. Special Categories of Data: Additional section when collecting sensitive data like health information or biometric data

2. International Transfer: Required when personal data may be transferred outside of Canada

3. Parental/Guardian Consent: Needed when the individual is a minor or lacks capacity to provide consent

4. Digital Communication Consent: Optional section for consent to receive electronic communications

5. Photography/Media Release: When consent includes permission to use photos or other media

6. Research Participation: When consent is for participation in research studies

7. Financial Information Handling: When collecting financial or payment-related information

Suggested Schedules

1. Privacy Policy Summary: Simplified version of the organization's privacy policy highlighting key points

2. Data Processing Activities: Detailed list of specific data processing activities covered by the consent

3. Third-Party Processors: List of third-party service providers who may have access to the data

4. Withdrawal Form: Template form for withdrawing consent in the future

Authors

Alex Denne

Head of Growth (Open Source Law) @ Genie AI | 3 x UCL-Certified in Contract Law & Drafting | 4+ Years Managing 1M+ Legal Documents | Serial Founder & Legal AI Author

Linkedin in social icon imageX social icon image
alex.den.21@genieai.co
Relevant legal definitions
Personal Information
Sensitive Personal Information
Consent
Express Consent
Implied Consent
Data Collection
Data Processing
Data Subject
Organization
Third Party
Service Provider
Data Protection
Privacy Officer
Authorized Representative
Personal Health Information
Commercial Activity
Information Handling
Data Storage
Data Transfer
Withdrawal of Consent
Disclosure
Record
Electronic Communication
Privacy Notice
Data Retention
Applicable Privacy Laws
Authorized Purpose
Confidential Information
Legal Guardian
Digital Platform
Relevant Industries

Healthcare

Financial Services

Education

Technology

Retail

Professional Services

Research and Development

Non-Profit

Government Services

Marketing and Advertising

Human Resources

Insurance

Telecommunications

Relevant Teams

Legal

Compliance

Human Resources

Information Security

Risk Management

Operations

Customer Service

Marketing

Research

Information Technology

Privacy

Administrative Services

Data Management

Relevant Roles

Privacy Officer

Data Protection Officer

Legal Counsel

Compliance Manager

Human Resources Manager

Information Security Officer

Risk Manager

Operations Manager

Customer Service Manager

Marketing Manager

Research Coordinator

IT Director

Chief Privacy Officer

Chief Compliance Officer

Project Manager

Industries
Personal Information Protection and Electronic Documents Act (PIPEDA): Federal privacy law that sets ground rules for how private sector organizations collect, use, and disclose personal information in the course of commercial business
Digital Privacy Act: Amends PIPEDA to include mandatory breach reporting and record-keeping requirements, affecting how consent must be obtained for digital information collection
Consumer Privacy Protection Act (CPPA): Proposed legislation to replace PIPEDA's privacy provisions, introducing new consent requirements and privacy rights for individuals
Provincial Privacy Laws (e.g., PIPA BC, PIPA Alberta, Quebec's Bill 64): Provincial privacy legislation that may have additional or varying requirements for consent depending on the jurisdiction where the consent statement will be used
Personal Health Information Protection Act (PHIPA): Ontario's health privacy legislation, relevant if the consent involves health information in Ontario, with specific requirements for health information consent
Age of Majority Act: Provincial legislation that determines the age at which an individual can provide legal consent, varying by province
Electronic Commerce Act: Provincial legislation governing electronic signatures and digital consent mechanisms
Teams

Employer, Employee, Start Date, Job Title, Department, Location, Probationary Period, Notice Period, Salary, Overtime, Vacation Pay, Statutory Holidays, Benefits, Bonus, Expenses, Working Hours, Rest Breaks,  Leaves of Absence, Confidentiality, Intellectual Property, Non-Solicitation, Non-Competition, Code of Conduct, Termination,  Severance Pay, Governing Law, Entire Agreemen

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