Terms and Conditions (please check each box, to confirm you have read and accept these terms and
conditions):
I acknowledge that the bag tags are for use by the tenants of the registered accessory
apartment.
The tags are for use at the above noted address only, and cannot be transferred or re-sold. The
bag tags hold no cash value.
I also acknowledge that participation in Dufferin County’s Blue Box and Green Bin programs is
required under the Waste Services By-law, and agree to fully participate in these programs.
I certify that the information provided is, to the best of my knowledge, correct and complete.
Signature (not required for email submission below):
Date:
Notice with Respect to the Collection of Personal Information
Personal information requested on this form is collected as a necessary part of the administration
of Waste Services by the County of Dufferin pursuant to its legal authority as set out in the
Municipal Act, 2001. Collection, use and confidentiality of the personal information will be
according to the standards of the Municipal Freedom of Information and Protection of Privacy Act
and the information will be used for the purpose of verification of eligibility for specialized set out
service programming only. Questions or concerns about collection, use or disclosure of personal
information should be directed to the Director of Public Works at 519-941-2816 ext. 2600.
