trikappa.org Photo Release Form

Please fill out completely.

Date submitted:

 
First and last name of person in photograph:

 
Age of person in photograph, if under age 18:

 
First and last name of Parent or Legal Guardian if the above is under 18:

 
E-mail address:

 
Mailing address:

 
Phone number (including area code):

 
First and last name of person responsible for information:  
E-mail address:

 
Mailing address:

 
Phone number (including area code):

 
Greek  Name:

 
Chapter City:

 
Name of article the photo is attached to:

 
Dates the information will be active on the site:

 
Please list the name of the file this photo is in or give a description of the photo if submitted by regular mail:

 
Name of photographer:

 
Date photo was taken:

 
Photographer has given permission to use photo? (circle one)

Yes                     No

 

 

Please read carefully and sign and mail to the webmaster:

I have read and understood the terms of the User Agreement of trikappa.org. I understand a photo of me (or my child as stated above) and its identifying information will be made available for viewing on the World Wide Web. I give my permission for the above named photo to be posted on trikappa.org. I agree to indemnify and hold harmless from any claims the following: Kappa Kappa Kappa, Inc., trikappa.org, all officers, employees, and representatives of Kappa Kappa Kappa, Inc.  I understand that any request to remove a photograph must be made in writing to the centraloffice@trikappa.org or mailed to Central Office.  It will take up to two business days to remove photographs after the request is received.

 

Date:_________________________ Signature:______________________________________________________

(Parent or legal guardian if under 18)

 

 

 

Contact us:  centraloffice@trikappa.org
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