Self-serve photography application form
Clients must visit the consultation desk with the form below for validation.
We will make a green copy for you.
Personal information
| Name |
First name:User can enter their first name in this location |
Last name:User can enter their last name in this location |
| User card number |
User can enter their 14-digit user card number in this location |
| Authorization date |
From:User can enter their requested authorization "from" date in this location |
To:User can enter their requested authorization "to" date in this location |
List of items you'd like to photograph
Shaded area to be filled out by staff.
| Item number |
Reference number |
Restrictions
(contractual and ATIP only) |
Verified by |
| 1. |
Reference number |
Any restrictions |
Name of staff member who verifying this information |
| 2. |
Reference number |
Any restrictions |
Name of staff member who verifying this information |
| 3. |
Reference number |
Any restrictions |
Name of staff member who verifying this information |
| 4. |
Reference number |
Any restrictions |
Name of staff member who verifying this information |
| 5. |
Reference number |
Any restrictions |
Name of staff member who verifying this information |
| 6. |
Reference number |
Any restrictions |
Name of staff member who verifying this information |
| 7. |
Reference number |
Any restrictions |
Name of staff member who verifying this information |
| 8. |
Reference number |
Any restrictions |
Name of staff member who verifying this information |
Terms governing the reproduction and use of material from the collection of Library and Archives Canada
General applicants
Users warrant that they will not use Library and Archives Canada (LAC) collections in a manner that would infringe the rights of others. Liability that may arise in the use of the copy is assumed in full by the user. LAC accepts no responsibility for unauthorized uses of collection material by users.
Request for the reproduction of personal information subject to Paragraph 8(2)(k) of the Privacy Act
LAC is subject to the Access to Information and Privacy Act and is responsible for maintaining and protecting the personal information under its control. On the basis of your representations and documentation evidencing your authority to access personal information for research or statistical purposes or for the purpose of researching or validating the claims, disputes or grievances of any of the aboriginal peoples of Canada, LAC discloses in good faith the requested personal information in accordance with these acts. The undersigned undertakes not to use the personal information disclosed by LAC for any other purpose than that set out above or in any manner that would infringe on the rights of others. LAC bears no responsibility nor shall it be liable for any consequences that flow from its disclosure of the personal information under its control.
Signature block
|
Signature:Signature location
|
Date:Date location
|