Homespun Hearth's
Quilting in the Rockies Retreat
The Inn at Palmer Divide
September 3 - 7, 2007

 

Personal Liability Waiver and Indemnification Agreement

 

Fill out this form and and then print and mail to:  
Homespun Hearth, 
C/O Retreats
15954 Jackson Creek Parkway
Suite B #564
Monument CO 80132 

Reservations will be confirmed when we receive this signed-form
 

You can make your initial deposit or full payment at this link
http://www.homespunhearth.com/detail.asp?product_id=ZM-Retreat-08

 
 

 

Your Name:

 

Emergency and Medical Information

In case of emergency, contact

 

Emergency contact’s phone

 

Anything we should know…food allergies, physical limitations, etc?

 
 

 

Personal Liability Waiver and Indemnification Agreement

All guests who attend this retreat must sign this liability & indemnification agreement.  Without your signature, your registration will not be finalized.
I hereby agree to indemnify Homespun Hearth, its owners, customers, representatives, transportation companies, and other guests from & agree to never make a claim for injury, loss, or damage to me, or anyone accompanying me, to the Homespun Hearth Quilting in the Rockies Fall Retreat.

Signature __________________________________________    Date _______________

 Printed Name_______________________________________