PITSTONE PARISH COUNCIL

9 Warwick Road, Pitstone, Beds, LU7 9FE
Tel: 01296 767261.  Email: parishclerk@pitstone.co.uk
Facebook: “Pitstone Parish Council” and “Pitstone Youth”
Twitter: @pitstone_pc    Web: www.pitstone.co.uk

Consent to Hold/Process Information Form

I agree that I have read and understand Pitstone Parish Council’s Privacy Notice (attached). I agree by signing below that the Council may process my personal information for providing information, corresponding with me, providing information and/or accessing your facilities and services.  Where relevant, I agree that the Council may share my personal information with necessary third parties to achieve these objectives eg pass my information to a County or District Councillor (please stipulate any restrictions below).

I agree that Pitstone Parish Council can keep my contact information data for an undisclosed time or until I request its removal. 

I have the right to request modification on the information that you keep on record.

I have the right to withdraw my consent and request that my details are removed from your database.

Name 	
	
Date of birth if under 18 		
Parental/Guardian Consent for any data processing activity (if under 18)		
Address	

Telephone No.		
Email Address
		
Facebook
		
Twitter		
Signature	

Particular purpose / restrictions on use or sharing
		
Date