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Last Trip Single Liability Waiver

  • I acknowledge that I am participating in an event managed by Jane Media LLC but that I am assuming all liability for this event.


  • I am aware that Last Trip Single (Jane Media LLC) is not responsible for my safety or my well-being during this event. 


  • I am aware that I have been strongly encouraged to retain my own travel insurance/protection for myself for this event. 


I Agree
I have been advised to secure my own travel insurance. If I do not secure my own travel insurance, I am aware I am solely responsible for any cancellation penalties and out of pocket expenses incurred.


Finally,

  • I will also make my own separate travel, medical and any other provisions in the event of an emergency while traveling. I also understand that I am not protected from loss in the event of any travel vendor, travel supplier, and/or any travel-related operator default. 


  • This waiver confirms I voluntarily declined to purchase my own travel insurance and travel protection for the trip, and/or I have retained my own travel insurance/protection at my own cost. I understand that I am solely liable for all airline fees, supplier fees, and/or agency fees that may apply and I hereby release Last Trip Single (Jane Media, LLC) of any and all liability related to the trip.


First Participant's Name
First Name*
Middle Name
Last Name*
Phone*
First Participant's Date of Birth*
Date of Birth
First Participant's Signature*
Second Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Third Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Fourth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Fifth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Sixth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Seventh Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Eighth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Ninth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Tenth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Parent or Guardian's Email Address
Email*
Confirm Email*
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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.


By signing below the Parent or Court-Appointed Legal Guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name
First Name*
Middle Name
Last Name*
Phone*
Parent or Guardian's Date of Birth*
Date of Birth
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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