Crop Inn - Gift Certificates

Start Your Registration for Palm Desert 2007

Information Needed Please
The information requested below will help us make your stay a memorable and enjoyable visit. Thank you for choosing Crop Inn!


Please complete the fields below, then click the Submit button. (*Indicates required field.)

General Info
*Name of Party:
*Your Name:
Other Names in your Party:
*Mailing Address: (Street, City, State Zip)
*Email Address:
*Daytime Phone Number:
*Payment By:	Credit Card Check
*Type of Retreat:	Self Service Mid Service Full Service
Self-Service Extended Hours Pkg:	Yes No
*2007 Weekend Date Selected:
Dietary Restrictions:
Food Allergies:
How long have you been scrapbooking?	years
Any classes or techniques you'd enjoy learning? (Not applicable to Self-Service Weekends.)
*How did you hear about us?
	If "Store" above, Name of Store:
Policies
*Release Agreement:	Release Liability Agreement The die cutting, eyelet setting, punch and scrapbook equipment provided at Crop Inn is for personal use while working at Crop Inn. If you are unfamiliar with the equipment please see instructions or ask. Please do not cut more than 2 pieces of paper at a time as this may cause damage to the tray, roller, foam or die blades. The foam side of the die must be facing up. Use die cuts, punches and equipment at your own risk. I understand that the scrapbook equipment ( including die cutting machine, dies, punches, eyelet setting equipment, and other equipment at Crop Inn), may cause injury if not used carefully and correctly. I release and agree to hold harmless, Crop Inn, for any injuries sustained to myself as a result of my use of the equipment which has been provided for my use. My signature indicates that I have read and understand the policies of Crop Inn and acknowledge the fact that I am solely liable for damage to equipment caused by improper use. Crop Inn, its officers and employees will be held harmless against all loss, expenses, damages and liabilities in the event of injury or accident caused by or to retreat registrant or her property. We advise you to leave your valuables at home. Crop Inn, reserves the right to expel anyone from the premises for inappropriate behavior or the intent to do harm to others. Anyone requested to leave will not receive a refund of any portion of their retreat fees. I consent to the use of photos or video in which I may appear, or quotes I make regarding Crop Inn to be used in the marketing and publicity of Crop Inn. I have read and understand the policies outlined above for Crop Inn.
	I Accept
Medical Info
*Authorization for Treatment:	In the event of an emergency, I hereby give permission to the medical personnel selected by Crop Inn, to order x-rays, routine tests, administer emergency treatment and to release any records necessary for medical or insurance purposes and to provide or arrange as necessary related transportation for me in the event an emergency contact is unable to be reached and I am unable to do so myself. I hereby give permission to Crop Inn personnel to secure and administer treatment, including hospitalization for me in the event I an unable to do so myself. This authorization shall remain in effect through the duration of my stay at Crop Inn.
	I Accept
*Medical Insurance Provider:
*Member/Policy Number:
*Physician's Name:
*Physician's Phone:
Please List Any Health Concerns:
Please List Any Allergies:
Emergency Contact
*Please List One or More Emergency Contacts:	Name & phone number please.