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 them
· Going with or without the owners on occasional outings in the
Town of Thurman
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