I acknowledge that the Corporation of the City of Windsor (“The City”) collects the personal information contained in this form in order to administer court services pursuant to the Provincial Offences Act. Questions or concerns about the collection of information may be directed to the POA Court manager at poa.tickets@citywindsor.ca or by phoning the court office at 519-255-6555.

I confirm that I am the defendant and/or that I am legally authorized to make a request for disclosure on behalf of the defendant.

I consent to the City sending emails to the email address I provide. I acknowledge that the City does not guarantee the confidentiality of disclosure sent by email, I assume all risk and liability associated with the use of email for providing disclosure, and I release and hold harmless the City from any liability associated with the use of email for providing disclosure. I understand that accommodations could be made to provide an alternate method of receiving disclosure by contacting the email address or phone number provided above.

I confirm that the information being provided is accurate, true and being given voluntarily.