Indian Residential School Commemoration Monuments

Consent and Nomination Form

In 2012, Grand Council Treaty #3 unveiled six monuments to honour the children of (both living and deceased) who attended Indian Residential Schools.

We are dedicated to expanding this tribute by adding the names of individuals from the 28 First Nation communities within Treaty #3 who attended Residential Schools. To include an individual’s name on the monument, please complete this consent form, which can be filled out by the individual or an authorized family member on their behalf.

Name to be included on the monument

First Name

Last Name

Repeater

Name of Residential school attended

Years Attended (if known)

Add Remove

Name of First Nation / Band Name

Clan/Dodem (if known)

Date of Birth

Email Address

Address

City

State/Province

Zip/Postal

Is this form being completed by someone other than the individual listed above?

Yes

I understand that by signing and submitting this form, I am giving authorization to Grand Council Treaty #3 to submit my name or the name of my relative for publication purposes for the Treaty #3 Anishinaabe Nation Indian Residential School monuments.

I Agree

Signature

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