Schaffer’s Mill – Guest Registration Form Step 1 of 3 33% Guest(s) InformationPrimary Guest Name* First Last Primary Guest Phone Number*Primary Guest Email Address* Guest Type*Please select guest typeDiscovery Package GuestAccompanied SMC Member GuestUnaccompanied SMC Member GuestEndorsed Accommodations Short-Term GuestNon-EA Short-Term Rental Guest# of Additional Guests*Does not include primary guest.Please select # of guestsN/A123456 or moreAdditional Guest Name - 1* First Last Additional Guest Name - 2* First Last Additional Guest Name - 3* First Last Additional Guest Name - 4* First Last Additional Guest Name - 5* First Last Additional Guest Names*Home InformationSponsoring Member Name First Last Schaffer's Mill Property Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Arrival Date* MM slash DD slash YYYY Departure Date* MM slash DD slash YYYY Liability WaiverASSUMPTION OF RISK, RELEASE, WAIVER OF LIABILITY AND INDEMNITY AGREEMENT ("AGREEMENT") In consideration for being permitted to participate in activities and events at Schaffer's Mill Club ("Coordinator"), I for myself my personal representatives, spouse, assigns, estate, heirs and next of kin (collectively "I"): Voluntary Participation: Acknowledge, understand and agree I am participating voluntarily and agree to be completely responsible for my own actions. I further agree to abide by all safety standards, rules and guidelines, which may be imposed by the Coordinator. Acknowledgment and Assumption of Risks: Fully understand that: (a) use involves risks of serious bodily injury, including permanent disability, paralysis and death ("Risks"); (b) these Risks and dangers may be caused by my own actions, or inactions, the actions or inactions of others, the Coordinator, the conditions, or the negligence of the Releases (defined below); (c) there may be other risks and social and economic losses either not known to me or not readily foreseeable at this time; and I fully accept and assume all such Risks and all responsibility for losses, costs and damages I incur as a result. Release: Covenant, promise and agree I will not prosecute or present any claim for personal injury, property damage or wrongful death or any other action against the Coordinator, others, or their respective, officers, trustees, administrators, executors, personal representatives, next of kin or any other representatives ("Releases") and hereby release, waive, discharge, relinquish any action or causes of action, which may hereafter arise from any and all liability, claims, demands, losses or damages on my account caused or alleged to be caused in whole or in part by the negligence or other acts or omissions of the Releases or otherwise, including injuries received or that may have been compounded or increased by negligent operations or procedures of the Releases. Indemnification: Covenant, promise and agree to defend, indemnify and hold the Releases harmless from any and all claims, actions, suits, procedures, costs, expenses, damages and liabilities, including attorneys fees, that arise out of or are in any way related to my involvement or participation. Miscellaneous: Hereby declare I am of lawful age and legally competent to sign this Agreement, I understand the terms herein are contractual and not a mere recital and I have signed this document of my own free will. I further acknowledge, understand and agree that the covenants and releases in this Agreement are intended to be as broad and inclusive as is permitted by the laws of the State of California and if any portion of this Agreement is held invalid, I agree that the balance, notwithstanding, continue in full legal force and effect. If any claim arises, I agree that this Agreement shall be interpreted under the laws of the State of California. I ACKNOWLEDGE THAT I HAVE READ THIS AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND HAVE SIGNED IT FREELY AND WITHOUT INDUCEMENT OR ASSURANCE OF ANY NATURE AND INTEND IT TO BE A FULL RELEASE OF ALL LIABILITY TO THE GREATEST EXTENT PERMITTED BY LAW.I have read and understand the Terms above.* Yes Primary Guest Name* First Last Primary Guest e-Signature*Date* MM slash DD slash YYYY Emergency Contact InformationThe following information is REQUIRED to be completed in case of an emergency. The Coordinator reserves the right to contact the emergency contact; such contact may be without the approval of the guest(s).Contact Name* First Last Contact Phone Number*Contact Alternate Phone NumberContact Email Address
