The information on this form is collected under the authority of the Education Act, the Smoke-Free Ontario Act and the Health Protection and Promotion Act in accordance with the Municipal Freedom of Information and Protection of Privacy Act. This information may be used for the delivery of public health programs and services; the administration of the agency; registries and related research, in compliance with legal and regulatory requirements. Questions about collection of this information should be addressed to Client and Community Support at 1-800-265-7293 ext. 7006 or clientcommunitysupport@wdgpublichealth.ca.