Request your decal

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Your Information

First Name

Last Name

Phone Number

Email

Your Business's Information

Business Name

Address

City/Town

Province

Postal Code

Business Phone

Business Email

Number of decals you are requesting

Comments

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I understand that the business information is collected for use by Northern Health to identify breastfeeding friendly environments across the North and the business information you provide may be disclosed to the public at large through various communication mediums, including but not limited to Facebook, Twitter, and Northern Health websites.

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Information collected if for use for the Growing for Gold program, information may be shared on NH Facebook page, and NH Twitter feeds. Information collected will be shared as per the Freedom of Information and Protection of Privacy Act (FOIPPA) for the purpose of this program.

Northern Health collects, stores and shares your personal information under the authority of the Freedom of Information and Protection of Privacy Act (British Columbia). Northern Health will take all reasonable steps to make sure your personal information is treated confidentially, stored securely and used only for the purposes of providing you with health care services and treatment. For additional details, please read our Collection of Personal Information document. If you have questions, or would like to access or correct your information, please contact Northern Health’s Privacy Office at privacy@northernhealth.ca.