Permission to Adapt Health Unit Resources

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Copyright Consent Form

Please identify the title of Leeds, Grenville and Lanark District Health Unit product you would like to use:(Required)

Describe how the work will be adapted and the purpose for its use:(Required)

Date(Required)

Name(Required)

First Name Last Name

Position Title(Required)

Organization(Required)

Organization Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone(Required)

Email(Required)

Do you need electronic copy of original artwork or want to modify the design? (any Getty Images will be removed due to licensing)(Required)

Yes

Will you need Getty Image reference numbers?(Required)

Yes

NOTE: We use InDesign and Illustrator so Microsoft Word documents may not be available for content.

The Leeds, Grenville and Lanark District Health Unit grants the user permission to reproduce or adapt the work upon agreeing to the following conditions:

i. The user acknowledges the work and the copyright are owned by the Leeds, Grenville & Lanark District Health Unit.

ii. All copies of the work shall bear the following notice:
Adapted (Reprinted) with permission from the Leeds, Grenville & Lanark District Health Unit

iii. The user shall use the work only for the requested purposes and not be used for sale or profit.

iv. Images may be licenced for this agency only and cannot be modified, used alone or in the creation of other resources. Please request an electronic copy of the artwork if you intend to adapt the design in any way.

I agree to use the resource as indicated above and follow the conditions(Required)

I agree

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