I hereby grant permission to the Hamburg Soccer Club to use my photograph on its World Wide Web site or in other official Hamburg Soccer related printed publications without further consideration, and I acknowledge the Club’s right to crop or treat the photograph at its discretion. I also acknowledge that the Club’s may choose not to use my photo at this time, but may do so at its own discretion at a later date.

I also understand that once my image is posted on Hamburg Soccer Club's website, the image can be downloaded by any computer user. Therefore, I agree to indemnify and hold harmless from any claims the following:

·             Board Members of Hamburg Soccer Club

·             All Coaches, Hamburg Soccer Club

·             All Volunteers, Hamburg Soccer Club

Hamburg Soccer Club reserves the right to discontinue use of photos without notice.

Name: ___________________________________________________________

Date: ____________________________________________________________

Address: __________________________________________________________

Team: ____________________________________________________________

Phone: ___________________________________________________________

eMail: ___________________________________________________________

Signature: _________________________________________________________

Please email this form to: Lew Potter at Directorofcoaching@hamburgsoccerclub.com

Or send to: HAMBURG SOCCER CLUB, P.O. Box 435, Hamburg, NY 14075