• TRIP  REGISTRATION  FORM

  •  /  /
    Pick a Date
  •  /  /
    Pick a Date
  • Contact Information

  •  /  /
    Pick a Date
  •  -  -
  •  -  -
  • Browse Files
    Drag and drop files here
    Choose a file
    Cancel of
  • Passport Information

    We will need this in the case that internal flights are being booked
  •  /  /
    Pick a Date
  •  /  /
    Pick a Date
  • Browse Files
    Drag and drop files here
    Choose a file
    Cancel of
  • Health & Emergency Contact Information

  •  -  -
  •  -  -
  • Are there any physical or mental conditions for which you have received medical treatment or for which you are currently receiving medical treatment? Please include RECENT SURGERIES, PROBLEMATIC OLD INJURIES, any MEDICATIONS you are currently taking and all ALLERGIES?

  • Trip Costs, Cancellation Policy & Insurance

    Please fill in the required fields and read the following information carefully
  • Cancellation Policy

    • To guarantee your place on any tour, a non-refundable deposit is required.
    • Payment in full is required when booking is made within 120 days before the departure date. Space is subject to cancellation by Pixelchrome, Inc. if payment is not received when due.
    • Final payments are due 90 days before the start of the trip. If you wish to cancel your tour you must send notification in writing to: Pixelchrome, Inc, 605 Rouen Drive, McKinney, TX 75072 or via e-mail to: nicole@pixelchrome.com
    • NO REFUND will be provided for a Pixelchrome, Inc Photography Tour/Workshop which has been paid in full within 90 days of departure or anytime after departure.
    • We strongly urge you to evaluate your risk and to take out Travel Insurance in the event that bad weather, illness or any other emergency, causes delays or prevents you from reaching your destination during your trip. This should also cover any losses which you may incur, for which Pixelchrome, Inc is not responsible.
    • Refunds for services that are voluntarily not used by you cannot be made.
  • Clear
  • Travel Insurance

    • Each participant must be covered by medical insurance that is valid overseas.
    • We strongly urge you to evaluate your risk and to take out Travel Insurance on your trip. It is vital for you to realize that if you experience a delay or find it necessary to cancel or cut short your trip for any reason, you will lose part or the entire sum you have invested in it. Travel insurance helps to minimize the risk of monetary losses you would incur in the event of a delay of your departure due to weather, airline strike, missed connection, etc., your inability to travel for reasons such as illness, injury, unforeseen financial complications and other personal circumstances, or if you were required to cut your trip short for medical or any other reasons. There are restrictions and limitations on any insurance program. For this reason, choose your insurance carefully. Check their policies regarding trip cancellation, baggage, and medical insurance. It is to your advantage to apply for insurance at the earliest possible time, so don't delay in making a decision.
    • We recommend Allianz Global Assistance, formerly Access America http://www.allianztravelinsurance.com
  • Subject to Change

    This itinerary has been carefully designed to assure participants the best this destination has to offer; however, should events arise that are beyond our control, activities and hotel arrangements are subject to change without notice. Be assured that we will make substitutions that are as similar in quality and interest as possible.

  • Participant Agreement, Release & Assumption of Risk

    Please read the following information carefully. To participate in a Pixelchrome, Inc photography tour, you are required to read through the following liability waiver, and having done so, acknowledge your full agreement with the electronic signature below. This is required prior to paying your tour/workshop deposit on line. Should you choose to pay your deposit by sending a wire or cheque, you are required to complete and submit this form.
    1. Depending on the nature of the photography tour, you may also receive another liability waiver from a professional guide service outfitting the trip. You will be required to sign and return that form as well in order to participate in the program.
    2. By choosing to attend a Pixelchrome Photographic Tour, you are accepting certain risks. Your application shall serve as a release of our liability and a complete assumption of all risks by you and your heirs, administrator, executor, successors, and assign for all family members. By accepting our terms of service with the signature of this waiver, you fully acknowledge that you are aware that travel, wherever it may be, and by whatever means, involves some inherent risk of injury, illness, death, loss, or damage to personal property, which may be caused by acts of nature, negligence or actions of others.
    3. In consideration of, and as part of the payment for your participation in a program, tour/workshop, excursion, expeditions, other activities, or any program that Pixelchrome, Inc, or their assigns, may be conducting, you are voluntarily releasing Pixelchrome, Inc, their employees, assigns, independent contractors, or anyone involved thereof, from any damages, liabilities, costs, damage to or loss of equipment of other valuables, injuries whether mental or physical, known or unknown, and by participation you agree to assume all risks yourself, whether known or unknown. You acknowledge that your choice to travel to areas that may be remote, foreign, mountainous, wilderness, wild rivers, remote deserts, all of which may not be maintained to the standards to which you are accustomed, may therefore involve certain additional risks, dangers, and inconveniences including, but not limited to, terrorism, forces of nature (force majeure), wild animals, hotel accommodations, airplane, vehicles, trains, boats, roads, walkways, trails, and other means of conveyance or other unknown risks. You acknowledge that medical services and facilities may not be readily available during all or part of the trip, including medical care, presence of physicians, and medication. We assume no liability for medical care. We assume no liability for dietary requirements you have.
    4. Your application and the payment of your deposit signifies your full understanding and agreement that you release and hold harmless Pixelchrome, Inc, its officers, agents, sponsors, associates, sub-contractors, from any and all liability, actions, causes of actions, claims, debts, and demands of every kind whatsoever, known or unknown which may arise in connection with your participation in any activities arranged by them without limitation, all liability, actions, causes of action, claims, debts, and demands related to the negligence of said persons.
    5. You also acknowledge that you understand that travel with a group invariably involves compromise in order to accommodate the diverse desires, travel goals, personalities, and physical abilities of group members. You also agree that while itineraries are carefully planned, they are not a guaranteed schedule of activities, events, or participation, but only an intended guideline subject to available conditions on location. Group participants must allow for flexibility and changes deemed necessary by the program leader or professional guides, according to situations that may arise beyond our control, including but not limited to geographic, climatic, physical, or governmental restrictions that will cause further changes in timing, locations, and activities. In acknowledging this, you further agree that there will be no discounts or refunds for activities curtailed or otherwise affected by such circumstances.
    6. You have assumed the responsibility to select an activity appropriate to your physical abilities and interests. You are personally responsible for being in sufficiently good health to undertake the activity. By submitting this signed application and by your deposit, you accept our terms of service, and you certify that you do not knowingly have any physical or other considerations of disability that would create a risk for you or other participants. We reserve the right to request a doctor's statement of good health.
    7. You will be responsible for studying all pre-trip information; for bringing all equipment, personal items, and appropriate clothing; for conforming to standards of dress and hygiene; and for acting in a manner considerate of fellow participants, locations and environments, models, and locations. We reserve the right to cancel any activity and to accept or reject any person as a member of any activity at any time before or during the tour/workshop for which you are applying. The program, tour/workshop, expedition, excursion, or trip leader’s judgment shall provide the ultimate determination of an individual's ability to participate in, or continue to participate in, any activity or program. In acknowledging this, you further agree that there will be no discounts, refunds, or cost reimbursements resulting from activities curtailed or otherwise affected by such circumstances.
    8. You acknowledge that travel to foreign countries entails unanticipated risks which could result in physical or emotional injury, paralysis, death, or damage to yourself, to property, or to third parties. You understand that such risks simply cannot be eliminated without jeopardizing the essential qualities of the activity. The risks include, among other things: the hazards of walking on uneven terrain (cobblestones) and slips and falls, street muggings, hijacking, your own physical condition.
    9. You expressly agree and promise to accept and assume all of the risk existing in this activity. Your participation in this activity is purely voluntary, and you elect to participate in spite of the risks.
    10. You hereby voluntarily release, forever discharge, and agree to indemnify and hold harmless Pixelchrome from any and all claims, demands, or causes of actions, which are in any way connected with your participation in this activity, including any such claims which allege negligent acts or omissions of Pixelchrome.
    11. Should Pixelchrome or anyone acting on their behalf, be required to incur attorneys' fees and costs to enforce this agreement, you agree to indemnify and hold them harmless for all such fees and costs.
    12. You certify that you have adequate insurance to cover any injury or damage you may cause or suffer while participating, or else you agree to bear the costs of such injury or damage yourself. You further certify that you are willing to assume the risk of any medical or physical condition you may have.
    13. In the event that you file a lawsuit against Pixelchrome, you agree to do so solely in the state of Texas, and you further agree that the substantive law of Texas shall apply in that action without regard to the conflict of law rules of that state. You agree that if any portion of this agreement is found to be void or unenforceable, the remaining document shall remain in full force and effect.
  • Signature

    I agree to all of the conditions set out in this document including the Cancellation Policy which I have read and understood. I further acknowledge that if anyone is hurt, or property is damaged, during my participation in this activity, I may be found by a court of law to have waived my right to maintain a lawsuit against Pixelchrome on the basis of any claim from which I have released them herein. I have had sufficient opportunity to read this entire document. I have read and understood it, and I agree to be bound by its terms.
  • Clear
  • Should be Empty:
Jotform Logo
Now create your own JotForm - It's free! Create your own JotForm