Adirondack Mountain Writers' Retreat

"Living to Tell the Tale"
A Three-day Memoir Workshop
led by
Irene Sherlock

Presented by Perky Granger
With special support from the Adirondack Center for Writing

urman, NY, August 22-24, 2008

Waiver and Assumption of Risk

Adirondack Retreat Home - Beaver Meadow Lodge - Contact - Persis Granger Home -
Registration for Retreat -

Please print this page, fill in, sign and return with reservation form.

I, ____________________________________________________, Customer, of

(your address) __________________________________________________________,

State of ______________________, voluntarily sign this waiver and assumption of risk in favor of Persis R. Granger of 11 Clarence Russell Road, Warrensburg, NY 12885, Owner, in consideration for the opportunity to use the owners' facilities and/or the opportunity to receive instruction from the owner or the owners' employees, and/or to engage in the activities sponsored by the owners, as follows:

· Residing in or participating in activities at sites arranged by the owners, Beaver Meadow Lodge,
· Sharing meals, snacks and beverages prepared by the owners or those engaged by them
· Participating in workshops, discussions and writing exercises led by the owners  or those engaged by
· Going with or without the owners on occasional outings in the Town of Thu
rman and surrounding area

I understand that there are certain risks and dangers associated with the activities and use of the facilities.

I fully assume the risks involved as acceptable to me and I agree to use my best judgment in undertaking these activities and follow all safety instructions.

I waive and release the owner from any claim for personal injury, property damage, or death that may arise from my use of the facilities or from my participation in the activities or instruction. I am a competent adult, aged 21 or older, and I assume these risks of my own free will.

Dated _____________________________, 20 ______

Signature of Customer

Printed Name of Customer