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Travel Insurance DECLINE Waiver

I have been advised of the importance of purchasing a travel insurance policy to protect my travel investment. 

I decline the offer to purchase travel protection / trip insurance for the trip related to this document. I understand that I am solely responsible for any cancellation penalties and out-of-pocket expenses incurred. I will also make my own separate travel, medical and any other provisions in the event of an emergency while I am traveling. I also understand that I am not protected from loss in the event of any travel vendor, travel supplier or any travel-related operator default. 

This waiver confirms that I voluntarily decline travel insurance and travel protection insurance for the trip. I understand I am solely liable for all airline fees, supplier fees, and agency fees that may apply, and I hereby release Scuba X Travel, SXT Adventures, Aquatic Outfitters dba Scuba Schools of America, their agents, heirs, assigns, representatives and hired, unrelated third-party suppliers and operators from any and all liability related to the trip described above.

 

First Travel Guest's Name

First Name*

Last Name*

Phone*
First Travel Guest's Date of Birth*
First Travel Guest's Trip Information

Trip Destination (where will you be traveling to?) *

Date of Departure: (this is the date you leave home for this trip) *

Date of Return: (this is the date you arrive back home, not necessarily the date you leave your destination) *
First Travel Guest's Signature*
Second Travel Guest's Name

First Name*

Last Name*
Second Travel Guest's Date of Birth*
Second Travel Guest's Trip Information

Trip Destination (where will you be traveling to?) *

Date of Departure: (this is the date you leave home for this trip) *

Date of Return: (this is the date you arrive back home, not necessarily the date you leave your destination) *
Third Travel Guest's Name

First Name*

Last Name*
Third Travel Guest's Date of Birth*
Third Travel Guest's Trip Information

Trip Destination (where will you be traveling to?) *

Date of Departure: (this is the date you leave home for this trip) *

Date of Return: (this is the date you arrive back home, not necessarily the date you leave your destination) *
Fourth Travel Guest's Name

First Name*

Last Name*
Fourth Travel Guest's Date of Birth*
Fourth Travel Guest's Trip Information

Trip Destination (where will you be traveling to?) *

Date of Departure: (this is the date you leave home for this trip) *

Date of Return: (this is the date you arrive back home, not necessarily the date you leave your destination) *
Fifth Travel Guest's Name

First Name*

Last Name*
Fifth Travel Guest's Date of Birth*
Fifth Travel Guest's Trip Information

Trip Destination (where will you be traveling to?) *

Date of Departure: (this is the date you leave home for this trip) *

Date of Return: (this is the date you arrive back home, not necessarily the date you leave your destination) *
Sixth Travel Guest's Name

First Name*

Last Name*
Sixth Travel Guest's Date of Birth*
Sixth Travel Guest's Trip Information

Trip Destination (where will you be traveling to?) *

Date of Departure: (this is the date you leave home for this trip) *

Date of Return: (this is the date you arrive back home, not necessarily the date you leave your destination) *
Seventh Travel Guest's Name

First Name*

Last Name*
Seventh Travel Guest's Date of Birth*
Seventh Travel Guest's Trip Information

Trip Destination (where will you be traveling to?) *

Date of Departure: (this is the date you leave home for this trip) *

Date of Return: (this is the date you arrive back home, not necessarily the date you leave your destination) *
Eighth Travel Guest's Name

First Name*

Last Name*
Eighth Travel Guest's Date of Birth*
Eighth Travel Guest's Trip Information

Trip Destination (where will you be traveling to?) *

Date of Departure: (this is the date you leave home for this trip) *

Date of Return: (this is the date you arrive back home, not necessarily the date you leave your destination) *
Ninth Travel Guest's Name

First Name*

Last Name*
Ninth Travel Guest's Date of Birth*
Ninth Travel Guest's Trip Information

Trip Destination (where will you be traveling to?) *

Date of Departure: (this is the date you leave home for this trip) *

Date of Return: (this is the date you arrive back home, not necessarily the date you leave your destination) *
Tenth Travel Guest's Name

First Name*

Last Name*
Tenth Travel Guest's Date of Birth*
Tenth Travel Guest's Trip Information

Trip Destination (where will you be traveling to?) *

Date of Departure: (this is the date you leave home for this trip) *

Date of Return: (this is the date you arrive back home, not necessarily the date you leave your destination) *
Travel Guest's Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:*
City:*
State/Province:*
Zip/Postal:*
Parent or Guardian's Email Address

Email*

Confirm Email*
Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone Number*
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Last Name*

Relationship*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Trip Information

Trip Destination (where will you be traveling to?) *

Date of Departure: (this is the date you leave home for this trip) *

Date of Return: (this is the date you arrive back home, not necessarily the date you leave your destination) *
Parent or Guardian's Signature*
Electronic Signature Consent*
By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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