CAMPER SAFETY INFO & REGISTRATION DATA

Welcome! Your $325 Registration Fee includes two nights lodging, all meals and sessions, workbook, activities and good ol' fashioned camp fun - YUP, the full weekend. Just get yourself here.

Once you SUBMIT, you’ll be taken to a payment link. Upon receipt of payment, we will send you an email confirming your registration. At a date closer to Camp, you will be sent a Registration Packet with packing list, driving instructions, massage appointment form, and more.

Data is hand-processed and held STRICTLY confidential. We are committed to your enjoyment and wellbeing; this really IS a mountain camp, so please provide the following, as required by Camp Blogaway.

First Name
Last Name
Blog URL
Twitter Name @
Mailing Address 1
Mailing Address 2
City
State	Zip Code
Cell Phone
Phone	Ext
Email
Confirm Email
Gender Only used for cabin assignments	Male Female
Birthdate (mm/dd/yyyy) Helps with cabin assignments.

Emergency Contact Name
Relationship
Emergency Contact's Phone

Dietary Allergies? If allergic to specific foods or ingredients, list. If none, type "N/A".
Vegetarian? Give details. If not, type "N/A".
Allergies to medications: (including penicillin) This is in case of emergency. If none, type "N/A".
Medications you take that an emergency physician would need to know: If emergency treatment is required, this helps us help you. List your meds, please.
Conditions an emergency physician would need to know: If none, just type "N/A".
Disabilities/Special Needs: Provide info regarding any reasonable accommodations required. If none, just type "N/A".

Photo Release: By participating in Camp Blogaway activities, I consent to the use of any photographs, pictures, film or videotape taken of me or provided by me for publicity, promotion, website, television, multimedia or any other use, and expressly waive any right of privacy, compensation, copyright or other ownership right connected to same. Accept (if you DO want to be in the group photo, select "accept") Do Not Accept
* Camper Carries Insurance: Our facility, Camp de Benneville Pines requires that every camper carry their own respective medical and liability insurance to cover any injury or damage that might result from participation in Camp Blogaway activities. I Have Read and Acknowledge Self-Insurance Requirement
* Right to Expel Camper Without Refund: Camp Blogaway, in its sole discretion and without right to any refund, may refuse admission or require expulsion from the Premises for inappropriate, disruptive, or offensive behavior or the failure to act in accordance with Camp GetAway® principals and values. Alcohol Consumption: Camp Blogaway is committed to providing a safe and enjoyable experience for all participants. Consumption of alcohol may result in serious injury to yourself and others. Camp Blogaway reserves the right to expel any camper for abuse of alcohol. I Have Read and Acknowledge Expulsion Policy
Non-Discrimination Policy: Camp Blogaway does not discriminate on the basis of race, color, creed, national origin, sex, sexual orientation, physical challenges or age. Cancellation and Refund Policy: In the event you must cancel after paying for a registration, your cancellation request must be received in writing (via email or fax) at least 10 business days prior to the beginning of Camp. Your fee will be refunded, minus a $75 admin fee, regardless of the reason, including medical emergencies. No registrations are refunded after this 10-day cutoff. We cannot make exceptions to this policy. Prepaid Massage Cancellation: to receive a refund, email or fax your request, which must be received by noon PST the Wednesday before Camp. Missed appointments are not refunded. Refunds are issued by check within 30 business days after Camp concludes. There is a $25 service charge for returned checks. EMAIL: Patti@londre.com FAX: 310-889-0221.
* Release, Waiver and Indemity Agreement and Agreement to Assume Risk of Potentially Hazardous Activity: RELEASE, WAIVER AND INDEMNITY AGREEMENT AND AGREEMENT TO ASSUME RISK OF POTENTIALLY HAZARDOUS ACTIVITY For good and valuable consideration, the receipt and sufficiency of which is hereby conclusively acknowledged, including being permitted to participate in Camp Blogaway activities (the “Camp Activities”): The undersigned hereby acknowledges, agrees and represents that she, will inspect the premises, equipment and facilities where Camp Activities is conducted (the “Premises”). It is further warranted that the act of participation in Camp Activities is an acknowledgment that the Premises have been inspected, and that the undersigned finds and accepts same as being safe and reasonably suited for the purposes of participation in such Camp Activities. The undersigned hereby further acknowledges that participation in Camp Activities is a Hazardous Activity, and as such, could have unexpected and dangerous physical consequences which are inherent to the nature of any strenuous activity, such as chronic aches, pains, soreness, bruising, dislocation, joint damage, bone fracture, nerve damage, heart attack, stroke, other medical complications and even death, as well as allergic reaction to oils and body lotions, and that such consequences can appear days, weeks and months after Camp Activities. The undersigned further acknowledges that there are ever-present risks and dangers of bodily injury and death from using the Premises, either from her own actions or inactions, or as a result of actions or inactions of others. In further consideration of being permitted to participate in Camp Activities, the undersigned hereby agrees to the following: BEFORE COMMENCING ANY CAMP ACTIVITIES CONDUCTED BY CAMP BLOGAWAY, THE UNDERSIGNED WILL OBTAIN AN APPROPRIATE MEDICAL CHECKUP WITH HER FAMILY PHYSICIAN TO VERIFY THAT SUCH CAMP ACTIVITIES ARE APPROPRIATE FOR THE UNDERSIGNED’S PHYSICAL CONDITION. IF THE PHYSICIAN DISAPPROVES OR APPROVES BUT ONLY SUBJECT TO CERTAIN CONDITIONS, THE SAME SHALL BE COMMUNICATED IN WRITING TO CAMP BLOGAWAY AS A PRECONDITION TO PARTICIPATING IN CAMP ACTIVITIES. THE UNDERSIGNED HEREBY RELEASES, WAIVES, DISCHARGES AND COVENANTS NOT TO SUE Camp Blogaway, Camp de Benneville Pines, or its or their respective camp staff, coordinators, camp directors, body workers, employees, agents, and co-participants/other campers (hereinafter collectively referred to as “Releasees”) from all liability to the undersigned for any loss or damage, and any claim or demands on account of injury to the person or property or resulting in death of the undersigned, whether caused by the negligence, pre-existing medical condition, or physical over-exertion of the undersigned or otherwise, while the undersigned is in, upon or about the Premises. This includes without limitation injuries or damages which may result from physical contact with camp staff and coordinators, body workers, slipping or tripping and falling due to a dangerous condition of the property, improper maintenance of the Premises or equipment, inadequate security and/or inadequate supervision. THE UNDERSIGNED HEREBY AGREES TO INDEMNIFY AND SAVE AND HOLD HARMLESS THE RELEASEES and each of them from any loss, liability, damage or cost they may incur due to the presence of the undersigned in, upon or about the Premises (including without limitation, special, punitive, or consequential damages) whether caused by the negligence of the Releasees or otherwise. THE UNDERSIGNED HEREBY ASSUMES FULL RESPONSIBILITY FOR AND RISK OF BODILY INJURY, death or property damage due to the negligence of Releasees while in, upon or about the Premises and/or while participating in Camp Activities or due to the undersigned’s use of drugs or alcohol prior to or while participating in Camp Activities. THE UNDERSIGNED FURTHER EXPRESSLY AGREES THAT THE FOREGOING RELEASE, WAIVER AND INDEMNITY AGREEMENT AND AGREEMENT TO ASSUME RISK OF POTENTIALLY HAZARDOUS ACTIVITY IS INTENDED TO BE AS BROAD AND INCLUSIVE AS IS PERMITTED BY THE LAW OF THE STATE OF CALIFORNIA and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect. THE UNDERSIGNED HAS READ AND VOLUNTARILY SIGNS/ACCEPTS THE RELEASE AND WAIVER OF LIABILITY AND INDEMNITY AGREEMENT AND ASSUMPTION OF RISK OF POTENTIALLY HAZARDOUS ACTIVITY, AND FURTHER AGREES THAT NO ORAL REPRESENTATIONS, STATEMENTS OR INDUCEMENTS APART FROM THE FOREGOING WRITTEN AGREEMENT HAVE BEEN MADE. FURTHERMORE, THE UNDERSIGNED UNDERSTANDS THAT NO ONE OTHER THAN A DULY AUTHORIZED REPRESENTATIVE OF CAMP BLOGAWAY SHALL MODIFY THIS AGREEMENT. The undersigned agrees that: (1) participating in Camp Activities is not an “essential activity” as that term is defined by the California Courts (YMCA of Metropolitan Los Angeles V. Superior Court, 55 Cal. App. 4th 22, 1997), (2) that without the benefit of this release Camp Blogaway, could not provide reasonably priced Camp Activities without the risks and sometimes overwhelming costs of litigation, and (3) there are alternative recreational activities similar to the Camp Activities in the local area which may not require signing a release. I hereby waive any and all rights which I may have under the provisions of Section 1542 of the Civil Code of the State of California, which Section provides as follows: “A GENERAL RELEASE DOES NOT EXTEND TO CLAIMS WHICH THE CREDITOR DOES NOT KNOW OR SUSPECT TO EXIST IN ITS FAVOR AT THE TIME OF EXECUTING THE RELEASE, WHICH IF KNOWN BY HIM MUST HAVE MATERIALLY AFFECTED ITS SETTLEMENT WITH THE DEBTOR.” I fully understand that if any medical treatment or transportation is provided to me, with or without my consent, such treatment or transportation will be first aid type treatment or transportation, and I waive any and all claims or causes of action arising from or based upon the provision of such treatment or transportation, including claims or causes of action based upon the negligent provision of such treatment or transportation. I understand that there is no guaranty or expressed or implied promise that I will improve my physical or mental condition as a result of participation in Camp Activities. No amendment, modification, or supplement to this Agreement shall be binding unless it is in writing and signed by both me and Camp Blogaway. This Agreement is the entire agreement between us. This Agreement supersedes all previous agreements. If any term or provision of this Agreement is determined to be illegal, unenforceable, or invalid in whole or in part for any reason, such provisions shall be stricken from this Agreement, and shall not affect the legality, enforceability, or validity of the remainder of this Agreement. The undersigned represents and warrants that she is duly authorized and has legal capacity to execute and deliver this Agreement. This Agreement shall bind the heirs, executors and assigns of the undersigned. I HAVE CAREFULLY READ THIS RELEASE. I HAVE NO QUESTIONS TO ASK PRIOR TO SIGNING/ACCEPTING THIS AGREEMENT. THIS IS A LEGAL DOCUMENT AND I HAVE HAD THE OPPORTUNITY TO CONSULT MY ATTORNEY BEFORE SIGNING IT. I AGREE THAT THIS AGREEMENT SHALL NOT BE INTERPRETED AGAINST CAMP BLOGAWAY WHICH WROTE IT. I Have Read and Accept the Release