Print, Fill out all spaces, mail to exotictreks.com along with Full Payment.
Contact EXOTIC TREKS before sending in payment.
Make all Payments payable to: Larry Pruitt.
Po Box 26531
Eugene, Oregon USA 97402
Phone or Fax 1-541-687-6685
RELEASE OF LIABILITY AND ASSUMPTION OF RISK
I, ___________________________________________ am fully aware and understand that
travel in remote or civilized areas (by means of plane, boat, automobile, train, foot,
horseback or any other method of transport) as well as any of the activities that may
accompany the tour/trip vacation that I am participating in (such as, but not limited to,
trekking, paragliding, boating, climbing (with or without rope and equipment), mountain
biking, snorkeling, SCUBA diving, skiing (both cross country and downhill), hiking, etc.)
may involve certain risks, hazards or dangers such as, but not limited to: illness, injury
or death related to contact with various forms of animal, marine or plant wildlife,
illness, injury, or death related to the acts or forces of nature, civil disturbances,
terrorist acts, riots, thefts, government actions, wars, labor disputes, cultural
differences, equipment malfunction or failure, high altitudes, varied climates, lack of
immediate or ready access to medical facilities or services. I fully understand that these
risks, hazards or dangers may be present at any time prior to, during or after the tour
that I am participating in, and may be the result of any delay or change of itinerary, or
irregularity connected with the tour package which is beyond its control. I also fully
understand that in the event of a medical or personal emergency, evacuation to appropriate
or adequate medical facilities/services (if required) may not be immediately accessible
and may be lengthy, costly, or non-existent.
I acknowledge that I am voluntarily participating in this tour, and all activities, transport, etc. associated with this tour in full knowledge of the risks, hazards, or dangers involved, and I hereby agree to assume any and all risk involved, including, but not limited to injury, illness, damage to personal property, emotional trauma, and death. I further agree to release fully, and for all time, EXOTICTREKS.COM., and any of it's agents, employees, officers, directors, president, vice president, founder, successors, and associates from any and all claims, demands or actions, that may arise from my participation in this tour. This release of liability shall be binding upon me personally, as well as upon my heirs, legal representatives, assigns, and all family members (including any minors accompanying me). I intend this Release of Liability to be effective whether or not any loss, damage, injury, or death results from Negligence of EXOTICTREKS.COM. or any of its presidents, employees, agents, leaders, instructors, guides, officers, or representatives. I understand that negligence means failure to do an act which a reasonably careful person would do, or the doing of an act which a reasonably careful person would not do, under the same or similar circumstances to protect himself, herself, or others from injury or death.
I fully understand that all fares/rates, and tour dates have been quoted in good faith, but may be subject to change without notice, and at any time, in relation to currency exchange rates, and/ or any other contributing circumstances. I further understand that my specific rights relating to transportation, or carriage, are subject to the terms and conditions of the contracts of each individual supplier, or contractor, as represented in their individual documentation and/or ticketing supplied.
I agree that in the unlikely event I may have any claim against EXOTICTREKS.COM., I shall, within one year of the date that the claim arose, submit it exclusively in the courts of the State of Oregon, and that the prevailing party shall be entitled to recover it's costs and attorney's fees. I agree that should any part or portion of this Release Of Liability And Assumption Of Risk Agreement be found void and unenforceable that the rest of this agreement shall remain in effect. I agree that all questions of law shall be determined in accordance with the laws of the State of Oregon. Instead of a judicial determination of the parties' respective rights and obligations here under, the parties may agree to submit any dispute between the undersigned customer and EXOTICTREKS.COM. to binding arbitration by an independent arbitrator in the State of Oregon. Each party will pay one-half of the cost of such arbitration unless the arbitrator shall find either parties' position so frivolous and unfounded that the arbitrator may assess all costs of arbitration against a single party. The determination of such arbitration, including allocation of the cost of arbitration shall be final, binding, and enforceable in the same manner as and may be converted to an order of the District Court in the county of which the arbitration occurs.
I fully understand that EXOTICTREKS.COM. reserves the right to utilize any part or portion of any photographic image, record of film, or digital representation in which I may be a subject, and I agree that EXOTICTREKS.COM. may use any such photographic image, record of film, or digital representation for commercial and/or promotional purposes.
I confirm that I have carefully read and fully understand this document and it's contents. I also confirm that I have read, and agree to the terms and conditions on the attached document titled "Terms and Conditions". I also understand that I am fully responsible for any minors accompanying me.
I hereby voluntarily agree to participate in a tour with EXOTICTREKS.COM and willingly execute this agreement. I fully and completely understand it's contents and legal ramifications and specifically those in reference to my complete assumption of all risk, as well as my release of EXOTICTREKS.COM. of all liability.
Signature Of Applicant ________________________________________________ Date__________
(Parent of Legal Guardian must sign for persons under the age of 18)
If you are signing for a minor, list Name of Minor:___________________________________________
EXOTICTREKS.COM. - Tour Application
This form must be completely filled out.
(If you are traveling with minors (persons younger than 18 years of age) you must provide all the information below to us about each minor on a separate form and your relationship with the minor - minors must be accompanied with a parent or legal guardian that will assume all responsibility for the minor)
Tour you are signing up for: ___________________________________________ Departure Date:__________
Last Name:___________________________________ First Name:___________________MI:_____
Day Phone: (_____)_________________________Evening Phone: (____)____________________
Fax: (____)_____________________________ Email Address:________________________________
Web Site Address:_________________________________Occupation:___________________________
Passport #_________________________________ Date of Issue:_____________Exp. Date:_________
Place of Issue:_____________________________ Citizenship:____________________________
Date of Birth:_______________________________ Place of Birth:__________________________
Age: ________ Sex:________ Height:__________ Weight:______________
List name and phone number of your Medical Health Insurance company______________________________
In Case of Emergency Please Contact: _____________________________________________________
List Program of Regular Exercise (If any)________________________________________________
Describe Previous Travel/ Outdoor Activity Experience: _______________________________________________
If you will be doing any SCUBA activity please list: Certification Agency:__________________________
Card # ______________________________________
Special Diet / Health Concerns Or Needs:______________________________________________________
Foreign Languages Spoken and percent of knowledge: _______________________________________________
Accommodations: All accommodations have been arranged for double occupancy. In special cases quad occupancy may be used. Single accommodations can be arranged most of the time, but will be subject to a single supplement fee. Please Check your preference below:
Share accommodations with:______________________________________________
Where available we prefer 2 twin beds_______ 1 Full bed________
_______Single room and tent, if possible. Are you a smoker? Y/N________ I prefer a Non-smoker_________
Smoker________ No Preference_______
Air Arrangements (You must attach your full airline itinerary to this form, and notify us of any changes)
Departure City: _________________________________ Return City:_________________________
Terms and Conditions
Below is the payment schedule for the land cost of the tour. Airfare deadlines may be different.
Deposit - A deposit of $350 of which $100 plus any insurance charges is non-refundable, is required to reserve a space on any tour. (After the customer pays the Deposit he/she will need to be enrolled into a personal travel insurance program which may reimburse you if you cancel for certain reasons. Call the insurance company for details)
Our groups can fill up quickly. To reserve your space a deposit is required. We suggest booking your trip as soon as possible. This is to insure your space on the trip, and to prepare both mentally and physically for your adventure.
Travel insurance is NOT included in the price of the tour which may be able to cover your costs if you cancel. Talk with the travel insurance company to find out the details. (1-800-826-1300 - Travel Guard Total)
Below are the terms in which EXOTICTREKS.COM will be able to refund
your money. All other refunds most go through the travel insurance company.
Mail or Fax To Exotic Treks
Po Box 26531
Eugene, oregon USA 97402
Phone Or Fax 1-541-687-6685
EWA Cancellations & Refunds
Times of cancellation Customer's Charges
before 65 days $100 plus any insurance charges.
75 days - day of departure 100% of trip cost
No EXOTICTREKS.COM refunds will be given if you leave the tour for any reason, voluntarily or involuntarily, after the tour has begun. No refunds will be given for meals/transportation/accommodation or any other unused services.
Information about airline tickets refunds should be directed to the airline company that the tickets were purchased for. All EXOTICTREKS.COM tours may include Personal travel insurance at an additional cost. Which may reimburse you if you cancel for certain reasons. (Please call the insurance company if you have questions) Talk with the travel insurance company to find out the details. (1-800-826-1300 - Travel Guard Total)
All air flight information must be provided to EXOTICTREKS.COM before the tour begins. Which includes airline company name, flight number, time of departure and arrival, place of departure and arrival, name of Hotel you will be staying at and what nights you will be staying there. Phone numbers of where to contact you in case the plans change - (If possible)
Proof of adequate personal Medical insurance is required prior to departure on any tour/expedition.
The Travel Insurance is NOT included in the price of the tour Contact Travel Guard Total 1-800-826-1300. Talk with the travel insurance company to find out the details. This insurance should cover you for the entire time involved in the tour/expedition. Coverage should cover the country that you will be visiting, and include the following: theft/personal accident/personal liability/ ticket cancellation/lost luggage/ airplane cancellation or delay/medical expenses/repatriation. The coverage should reimburse you of the non-refundable air and land costs should you have to cancel due to a medical emergency or illness involving yourself, and family members traveling with you, unforeseen circumstances, inclement weather, as well as expenses incurred in conjunction with an emergency evacuation. Some personal medical insurance covers medical expenses while in other countries, check with your insurance company. Make sure you know the procedure to follow should you need to be reimbursed from your insurance company. You should also request to see the insurance contract. What is covered by the travel insurance is the sole responsibly of the insurance company only.
Please contact the travel insurance company if you have any questions. 1-800-826-1300 Travel Guard Total.
EXOTICTREKS.COM. acts as an agent in all areas of transportation and tour operations. In no way will EXOTICTREKS.COM. be held liable for any injury, damage, delay, inconvenience, accidents or personal loss that may occur as a result of, but not limited to, any of the following: the fault or default of other operators, individuals, agencies, companies, suppliers and contractors used to conduct any part of a tour, delays, or expense caused by strikes, theft, civil disturbance, government restriction or regulation, acts of God, forces of nature, civil disturbances, terrorist acts, riots, thefts, government actions, pirates, thieves, wars, labor disputes, equipment malfunction or failure, high altitudes, varied climates, lack of immediate or ready access to medical facilities or services, accident by aircraft or any form of transport, accident or loss in any hotel, guest house or any other form of accommodation, weather, the failure of any means of conveyance to arrive or depart as scheduled, or discrepancies or changes in transit or hotel services over which it has no control.
The traveler and the traveler's personal property, including baggage, are at all times solely at their own risk. Many of our programs are rendered by suppliers and contractors who are not agents nor employees of EXOTICTREKS.COM. The traveler understands that adventure travel, by it's very nature can at times involve risks or dangers that are not present in everyday life situations, including, but not limited to, accident, illness, crime, death, medical emergencies in remote areas without immediate or ready access to medical facilities, as well as natural disasters or forces of nature, government actions, and culture differences. The traveler agrees to assume all liabilities for any and all personal injuries, accidents or aggravation of medical conditions that are in any way related to the activities of the tour. EXOTICTREKS.COM. without liability, reserves the right, at any time to alter, amend, or cancel any tour or part thereof, if deemed necessary and any additional expenses, if any, will be charged to the traveler. Refunds will be at the discretion of EXOTICTREKS.COM.. In the event that a tour is canceled prior to departure, full refund of all monies received will constitute full settlement with the traveler.
EXOTICTREKS.COM reserves the right to decline, accept or retain any person as a member of any tour, at any time, if the tour leader determines that such person's mental health, conduct, or well being hinders the operation of the tour, or in any way jeopardizes the well-being or enjoyment of the other tour members. If a tour member is asked to leave a tour at any time, EXOTICTREKS.COM. will in no way be held liable for any of that person's further travel, transport or accommodation arrangements. EXOTICTREKS.COM will accept no responsibility or liability for any traveler who violates any law or regulation of any country visited. Any traveler who is detained as a result of an infringement of any law or regulation of any country, may be excluded from the tour without any claim or right to any refund.
You must be in general good health to take part in any of our programs, and each trip is rated according to the difficulty of the activities, number of nights spent camping, and elevations that will be reached. We recommend that you see your doctor and ask what inoculations, or medicine is recommended for travel to these areas. A doctor's signature of approval may be required for participants who are age 65 or older, and/or for those with a history of illness or inherent medical conditions. In the Andes, we may reach altitudes of up to 14,000 feet.
EXOTICTREKS.COM will assume no liability regarding the provision of medical care or first aid by our guides, or local physicians and emergency care facilities, in conjunction with any of our tours. Trip members are required to have a sufficient supply of personal medications (if needed). It is also understood that EXOTICTREKS.COM is not a medical facility nor are we physicians, and therefore have no expertise or responsibility regarding what medications or inoculations are necessary for your safe participation.
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