BENEDICTINE COMMUNITY OF NEW NORCIA INC.

- - - ARCHIVES - - -

New Norcia, Western Australia 6509

Telephone (08) 9654 8018 Facsimile (08) 9654 8097

REQUEST FOR ACCESS TO ABORIGINAL GENEALOGICAL RECORDS

Self - Surname _______________________________ Given Names ________________________________________

Address ________________________________________________________________________

Telephone No_____________________________________________________________

Parents Names _________________________________________________________________

PERMISSION TO ACCESS INFORMATION CONCERNING THE PEOPLE LISTED BELOW;

Relationship to those listed below who have given you permission to access their records

____________________________________________________________________

1 __________________________ Date Permission granted _____________________

2 __________________________ Date Permission granted _____________________

3 __________________________ Date Permission granted _____________________

4 __________________________ Date Permission granted _____________________

5 __________________________ Date Permission granted _____________________

Please use the other side of this form if you need more space.

I, (your name) ____________________________ undertake that I will be sensitive to the feelings to the above mentioned persons, by not telling other people details which may distress them or their families. I will not knowingly make any use of any information from these genealogical records which is likely to cause such stress. I will not make use of, or disclose to any other person any of the following without permission from the Abbot of the Benedictine Community and from any other person from whom the Archivist indicates permission is required:-

1. the personal names of Aboriginal persons who have died;
2. any details of Aboriginal ritual and/or ceremonial activities;
3. locations of significant Aboriginal sites.

Signed _________________________________ Date _________________________

Signed _________________________________ Date _________________________

Superior of the Benedictine Community of New Norcia Inc.