Women’s Weekend Service Provider Registration

How long will each session be? (e.g. 30 minutes for each tarot card reading)

The cost is $15/night.

I attest that the above health information provided is accurate and complete. I hereby grant permission to qualified instructors or other medical personal to secure and administer treatment, including hospitalization, for me in an emergency. This completed form may be photocopied for use on trips out of camp.

PLEASE READ CAREFULLY BEFORE ACCEPTING AND AGREEING. THIS ACCEPTANCE AND AGREEMENT IS A RELEASE OF LIABILITY AND THE WAIVER OF CERTAIN LEGAL RIGHTS. The undersigned person (volunteer) hereby acknowledges intent to work for the Takodah YMCA property. The Volunteer freely and unconditionally waives and releases Takodah YMCA and any personal representatives for any and all loss or damage and any resulting claims of demands due to injury to the person or property or death of the Volunteer, including those caused by alleged negligence of Takodah YMCA. The Volunteer further agrees to defend, indemnify and hold Takodah YMCA and staff harmless from and against any and all liabilities, demands, claims, damages, suits, judgments and decrees, and court awards including costs, expenses and attorneys' fees, on account of injuries to or death of any person or persons or damage to any property arising out of or related to the Volunteer's intentional or negligent acts, errors or omissions for the duration of the Volunteer's participation. The Volunteer understands that he is not an employee of the Takodah YMCA and agrees that he will not receive any compensation or benefit nor be eligible for any coverage under the New Hampshire Workers Compensation Laws. Please indicate that you understand and agree this statement below.

I authorize the reproduction, publication and use by the Takodah YMCA for promotional, marketing, public relations, or any other purpose, any pictures or likeness of me taken during the YMCA Camp Takodah Programs.