Photo Release Form

Kemah.Net

your Humble Webmaster & Photographer
Claire Durkee Worthington
2021 Anders Lane, Kemah, TX 77565
832-347-8837 email: Claire

Claire Worthington has my Permission to Use Photograph

I grant to Claire Durkee Worthington , her representatives and employees the right to take photographs of me and my property in connection with the above identified subject.  I authorize Claire Durkee Worthington, its assigns and transferees to copyright, use and publish the same in print and/or electronically.

I agree that Claire Durkee Worthington may use such photographs of me with or without my name and for any lawful purpose, including for example such purposes as publicity, illustration, advertising, and Web content.

I have read and understand the above:

Signature _________________________________

Printed name ______________________________

Organization Name (if applicable) __________________________

Address __________________________________

Date _____________________________________

Signature, parent or guardian _______________________ 
(if under age 18)