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By checking this box, you agree to have your personal information pursuant to this form collected by Living Healthy Champlain. This information is collected in compliance with section 38(2) of the Freedom of Information and Protection of Privacy Act. The information will be used for program information, program evaluation, and program follow-up and for no other purpose. If you have any questions about the collection, use or disclosure of you information, contact Living Healthy Champlain, at 1.877.240.3941, 43 Bruyère Street, Ottawa ON K1N 5C8 Canada
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