Region of Waterloo Form

Home/Exploring the Region/Library

Required fields are marked with asterisks (*)

Region of Waterloo Library Donation

Donor's Information

First Name:

Middle Initial:

Last Name:

Address: (Street, Apt. No., P.O. Box, R.R. No.)

City/Town:

Province:

Postal Code:

Country:

Phone number:

Email:

Donation Information

Donation Amount:

$20

$50

$75

$150

$250

Other

Is this donation:

In Memory Of

A Gift For

No Dedication

By continuing I confirm that:

i) I understand that The Regional Municipality of Waterloo operating as Region of Waterloo Library (the "Region") retains unconditional and complete ownership of the funds donated and/or items purchased with donated funds, and that I retain no ownership in such property.

ii) I understand that the Region's staff will use their best judgment about how this donation may best be used for the Region of Waterloo Library, and that I do not expect to be informed of their decision or have any control over such decision.

iii) The Region shall not be liable in any way to the donor for any damage, loss or injury of any nature whatsoever, or any costs or expenses that may be incurred because of any such damage, loss or injury, that may occur in the furtherance of the administration of the donation.

Personal information requested on this form is collected under the authority of the Municipal Act and will be used to maintain a record of the funds donated to the Department of Planning, Development and Legislative Services. Questions regarding this collection should be forwarded to the Manager, Public Services, Region of Waterloo Library at 150 Frederick St., 2nd Floor, Kitchener, ON N2G 4J3. 519-575-4590.