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SYNERGY COMMUNITY FARMS
& TEMPLE OF TANTRA ASHRAM
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I understand that Synergy Community
(SC) Temple of Tantra (TT) is located in a rustic, hilly and wild
area. I and my assignees, heirs, personal and legal representatives,
release from liability, hold harmless and will not make any claims
(present and future) against Synergy Community (SC) Temple of Tantra
(TT) or any of its staff, agents, contractors, guests or volunteers
for any physical or emotional injury, including death, that may
occur to me and accompanying children, animals or adults at Synergy
Community (SC) Temple of Tantra (TT); including but not limited to
slipping and falling, use of any pools or water including infections
or drowning and use of any trails; including but not limited to any
loss of any kind to my property or vehicle, whether resulting from
my own acts, the acts of others, acts of God or from acts of any
Synergy Community (SC) Temple of Tantra (TT) staff, agents,
contractors or volunteers. Synergy Community is a private, spiritual
members-only organization and reserves the right to terminate the
tenancy of a guest or member for reasons Synergy Community (SC)
Temple of Tantra (TT) shall deem objectionable. This form must be
approved by one of the head administrators of the Temple of Tantra.
I
agree to the terms and conditions of this agreement:
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Address
_________________________________ |
City _____________________
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State/Province
__________________________ |
Zip Code ____________
Country ___________ |
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Phone ____________________ |
Mobile ___________________
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Email
____________________________ |
Email
____________________________ |
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Vehicle Make
___________________ |
Vehicle
Model ______________________ |
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Color ___________________________ |
Car License
______________________ |
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Arrival Date
_____________________________
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Departure Date
___________________ |
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Guest Signature____________________________ |
Guest Printed
_________________________ |
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Date ___/___/___ |
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Sponsor Signature: ______________________ |
Sponsor Printed
_______________________________ |
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Date ___/___/___ |
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Approval Signature ____________________________ |
Approval Printed
____________________ |
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Date ___/___/___ |
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Mail Registration Form to:
Synergy Community Farms/Temple of Tantra, 1371 Malaihi Road, Wailuku, Maui, HI 96793 (808)
244-4921 or email to
synergyfarms@aol.com,
synergycommunity@gmail.com,
synergyfarms@gmail.com,
templeoftantra@gmail.com. We
look forward to hearing from you.
Do
not complete below this line:
Start Date ___/___/___ End
Date ___/___/___
Position: __________________________ Manager:______________________
Duties and responsibilities:
___________________________________________________________________________
___________________________________________________________________________
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