TRAVEL
CONSULTANT RELEASE
I, _________________________, (the “Participant”) hereby assume the risks
of participating in all Nancy Rosner (“Travel Consultant”) activities of every kind. I acknowledge that safaris, international
travel, and various activities to be conducted with Travel Consultant may carry
with them the potential for serious injury, death, and property loss; and that
my statements on this Release are being relied on by Travel Consultant in
permitting me to participate in any organized Travel Consultant activity.
I hereby irrevocably take the following action
for myself, successors and assigns:
·
I
WAIVE, RELEASE, AND DISCHARGE Travel Consultant, her agents, employees, and
contractors from any and all claims or liabilities for death, personal injury,
property damage, theft, damages, or loss of any kind, which arise out of or
relate to my participation in Travel Consultant activities; and
·
I
AGREE NOT TO SUE or make any claim of any kind against any of the persons or
entities mentioned above.
In the event of any dispute arising hereunder,
the same shall be submitted to a Court of competent jurisdiction in Orange County, California, and in all events the
laws of the United States and of the State of California shall govern this
agreement. I HEREBY AFFIRM THAT I AM
EIGHTEEN (18) YEARS OF AGE OR OLDER, I HAVE READ THIS DOCUMENT, AND I
UNDERSTAND ITS CONTENTS. If the
applicant is under eighteen (18) years of age, their parent/ guardian must sign
this Form AND the additional release below.
Printed
Name: ______________________________________ Signature: _____________________________________
Date:_____________
If the Participant is under 18 years of age, a
parent or guardian must sign the following release (in addition to the Form):
The undersigned _________________________
(parent/ guardian) is the parent and natural guardian or legal guardian of
_________________________ (minor Participant’s name), and hereby executes the
foregoing Form for and on behalf of myself and the minor named herein. I agree to the terms of this Form, on behalf
of the Participant and I hereby, in accordance with the terms of such Form,
agree to indemnify, release and hold
harmless Travel Consultant and Tour Director and the persons mentioned
above from all claims and liabilities which arise out of or relate to the
minor’s participation in Travel Consultant and Tour Director activities, or
traveling to and from any Travel Consultant and Tour Director activity.
Parent/
Guardian Signature:__________________________
Relationship to Minor:__________________________ Date:____________
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DEPOSIT AND RESERVATION FORM
To
reserve a space on the Kenya safari (on a first come, first served basis), please
read the tour features and conditions in this brochure, then complete the form
below.
Traveler 1
Name as it appears on
passport: _______________________________________________________ Suffix (Mr.,
Mrs., Ms.)___________________________
Address_____________________________________________________City_______________________________________State___________Zip____________
Phone(s)____________________________________________________email________________________________________________
Date of birth
________________________________________________Passport
number______________________________________
Traveler 2
Name as it appears on
passport: _______________________________________________________ Suffix (Mr.,
Mrs., Ms.)___________________________
Address_____________________________________________________City_______________________________________State___________Zip____________
Phone(s)____________________________________________________email________________________________________________
Date of birth
________________________________________________Passport
number______________________________________
Accommodation requested:
p Twin room (two persons in room with twin beds). Name
of person sharing room: _________________________________________________
p Double room (two persons in room with double, queen or king size bed). Name of person sharing room:___________________________________
p Single room (add $1500 per person for single supplement)
Reservations
for land accommodations are secured with a deposit on a first come, first
served basis.
Please
enclose a check in the amount of $500 per person payable to:
Mail
check to: Nancy Rosner
8905
Rhine River Avenue
Fountain
Valley, California 92708
I
have read and accept the terms and conditions as described in this brochure. Enclosed is my check for $_____________ as a
deposit for _____________person(s).
Balance must be received 120 days before departure.
Signature: _____________________________________________________________________________________ Date:
____________________________