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CONSENT FORM Anyone participating in the community digitization sessions was required to fill out the following waiver. The waiver was created to help avoid copyright disputes, and to give the library permission to place community material online. Name: ______________________ Phone: ______________________ Address: ______________________ Email: ____________@__________ ______________________ I, _____________________, hereby permit the County of Prince Edward Library & Archives to digitally reproduce and display the items listed below on the Internet. I am aware that any contextual information I provide may be included with the items online. In granting this limited permission, I do not surrender any of my rights to these materials. I agree to the fair use of the digital reproductions for personal study and not-for-profit educational uses. Item Description of item (title) Original format Unique Identifier No. of item 1 2 3 4 5 6 7 8 9 10 11 [ ] I am interested in being notified via email when the County of Prince Edward Library & Archives Collection website is released. __________________________ _______________ Signature of donor Date __________________________ _______________ Signature of Organization Rep Date