Form consent

Date adopted: 
February 21, 2018
Last update: 
July 31, 2023

There are instances where you might need to get consent from the person filling out a form to take an action. 

Consent and web forms

You can ask for consent in any part of a web form. To do this, include a checkbox beside the consent and make it mandatory the person select it to move forward or submit the application. 

Consent in a PDF form

The Consent section usually follows the Office use only section. Indicate consent by including a checkbox the person must select to submit the form.

How to write a consent statement

It's important you write the consent statement in plain language and it must fall in the required reading grade level of grade 6 to 9.

We've included some examples of rewriten consent statements below to help you achieve this. 

Exception: For PDF forms space is at a premium and it might not be possible to format your consent statement following this standard. Your forms designer will help you find the balance between following the standard and ensuring the content fits in the form. 

Example 1: Consent before it was rewritten

This example is reading grade 7 so it meets the reading grade standard. 2/5 sentences are hard to read. We can still make some improvements so it’s easier for people to understand.

Consent

A parent’s or guardian’s signature is required below for all students. This confirms consent for the student named above to be given a City of Whitehorse Transit Pass by Yukon Education. Note: Students will be subject to the City of Whitehorse Transit Passenger Code of Conduct. Students who choose to receive a free transit pass will not be eligible to ride the regular school bus.

Example 1: Consent after it was rewritten

In this rewritten example, the reading grade is 6, but by writing the text in the active voice and using bullets, the information is clearer.

Parent or guardian consent

I consent to the Department of Education providing the student(s) named above with a City of Whitehorse Transit Pass.

I understand the student(s):

  • must follow the City of Whitehorse Transit Passenger Code of Conduct; and
  • will not be eligible to ride the regular school bus.

Example 2: Consent before it was rewritten

In this example, there might be more information needed in the consent section. This is an example of consent for dental work. This version is reading grade 8.

Consent

Yes, I consent to my child receiving a dental examination by a dentist or dental therapist. As part of the examination, the services listed below may be provided by dental program staff.

You must indicate the service(s) you consent to your child receiving:

  • x-rays
  • cleaning of teeth
  • sealants
  • fluoride

Provide any additional notes for the dental program regarding your child’s treatment:

Following the dental examination, if your child requires restorative dental treatment (i.e. fillings, extractions, etc.) a Consent for Treatment form will be sent to obtain consent prior to providing treatment.

No, I do not consent to my child being enrolled in the Yukon Children’s Dental Program.

Example 2: Consent after it was rewritten

In this version, the reading grade is 5. We’ve used the active voice and created checkbox lists (indicated by bullets).

Parent or guardian consent

I consent to my child's enrolment in the Yukon Children's Dental Program. I understand a dentist or dental therapist will give them an exam.

I will allow staff to perform the following services, if needed.

  • x-rays
  • cleaning of teeth
  • sealants
  • fluoride

Is there anything else you want us to know about your child's treatment let us know.

Once we complete the exam, we'll contact you to get your consent for treatment (if needed).

No, I do not consent to my child's enrolment in the Yukon Children's Dental Program.

Withdrawing consent

You should always let people know how they can withdraw consent. Follow this example to create this type of content for your form.

Example: Withdrawing consent before it was rewritten

This version is reading grade 12 and 3 of the 4 sentences are hard, or very hard to read. We can rewrite this so it's easier for people to understand.

Withdraw your consent

At any time, you may withdraw or limit your consent to any or all collections, uses, and/or disclosures (sharing) of your information from the date of the request onward. If you wish to withdraw or limit your consent please speak to a member of COS team, as it may affect our ability to provide you with services. More information about Health and Social's information practices can be found at www.hss.gov.yk.ca/healthprivacy.php or by contacting the department's Privacy officer at [email protected].

Example: Withdrawing consent after it was rewritten

In this version we’ve removed the block of text and any information that doesn’t belong in this section. This has brought it to a reading grade 4.

Withdraw your consent

You can withdraw or limit your consent any time. This includes how we:

  • collect;
  • use; and
  • disclose your information.

Phone xxx-xxx-xxxx to speak to our staff. They will let you know if withdrawing your consent will affect your access to the service.

Your consent withdrawal starts from the date you contact us.