Waterloo Region Community Wellbeing Survey consent and information release

Waterloo Region survey partner logos

I understand by participating in the “Community Wellbeing Survey” initiative, my questionnaire responses are being collected by Wellbeing Waterloo Region (WWR) and the Canadian Index of Wellbeing (CIW), for the purposes of striving to improve the quality of life for all Region of Waterloo residents. 
I give permission to Wellbeing Waterloo Region to use my responses and share them with their partners, the University of Waterloo, and the Canadian Index of Wellbeing for the purpose of compiling a summary report based on the survey results.
Your participation is entirely voluntary and individual responses will be strictly confidential. There are no known or anticipated risks with your participation in the survey. You are not asked for your name or address at any point during the survey. You may skip questions that you do not wish to answer, but we believe that you will see how important all the information is in order to understand your perspectives on wellbeing. Only one adult member of your household, 16 years of age or older, needs to complete the survey.
All the findings will be reported at a level of geography that will not identify individuals (e.g., for the entire region or for individual townships). The data gathered will be presented in a report that will summarize the findings of the survey and will be made available to the public through the Wellbeing Waterloo Region website.
Given the information provided above:
I release Wellbeing Waterloo Region from any claims, demands, and causes of action in connection with the use of such information. I hereby give permission to use, collect, store, and dispose of my information for the following uses: (1) to help improve the quality of life of Region of Waterloo residents, (2) to develop a report that reflects the needs of residents geographically and to address the gaps, and (3) to be used by the Canadian Index of Wellbeing at the University of Waterloo to further research on community wellbeing.
I confirm that I have read the information linked to this consent and release form and understand the proposed uses of my information.  I understand that I may restrict/remove information from the website at any time by contacting Wellbeing Waterloo Region.