CONSENT AND INFORMATION RELEASE

Oxford County

I understand by participating in the “Oxford County Community Wellbeing Survey” initiative, my responses are being collected by Oxford County and the Canadian Index of Wellbeing (CIW), for the purposes of striving to improve the quality of life for all Oxford County residents.

I give permission to Oxford County 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. At no point during the study will we link your name to the responses to the questions. 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, 18 years of age or older, needs to complete the survey. All of your mailing information is protected by Canada Post and the third-party mailing house, which signed a confidentiality agreement with Canada Post. Neither Oxford County nor the Canadian Index of Wellbeing has access to the names and addresses.

All the findings will be reported at a level of geography that will not identify individuals (e.g., for all of Oxford County or for an entire community). 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 on the Oxford County website.

Given the information provided above:

I release Oxford County 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 Oxford County 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.