Travel Insurance Waiver

TRAVEL INSURANCE WAIVER

This form must be signed by every traveler over 17 years of age who is NOT obtaining travel insurance at the time of booking. Once signed, the waiver can be rescinded at any time should the traveler obtain travel insurance or you may submit a new form. Parents of minors, if you need to cover more than 3 minor children, please submit a 2nd form.
Date*

MonthDayYear
Name*

PrefixFirst NameMiddle NameLast NameSuffix
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Travel Start Date*

MonthDayYear
Travel End Date*

MonthDayYear
Trip Supplier
Confirmation # (optional)
Total Trip Cost*
Agency Cancellation Fee: $75.00 per person

Please refer to your specific trip's additional terms and conditions for the specific cancellation fee for that trip. This fee applies to Crowning Touch Travel, LLC only and is not included in any cancellation amounts charged by the supplier(s) inlvoved in your trip itinerary.
I have been offered and advised of travel insurance options by my travel agent, NICOLE R ROYAL.*

YesNo
Please indicate one of the below options as it relates to you.*

I will purchase travel insurance for myself through my own means at a later date. I understand that declining to purchase at this time indicates I am solely responsible for any cancellation penalties and out-of-pocket expenses which may be incurred prior to purchase. 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. I understand I am solely liable for all airline fees, supplier fees, and agency fees that may apply. I am also aware that all payments to Crowning Touch Travel, LLC / Crowning Touch Travel, LLC dba Diva Escapes and dba Gent Journeys are non-refundable and non-transferrable. I hereby release Crowning Touch Travel, LLC / Crowning Touch Travel, LLC dba Diva Escapes and dba Gent Journeys and its agents from any and all liability related to the trip described above. I further understand that if I fail to purchase travel insurance, this waiver shall serve as my decision to decline the purchase of travel insurance as outlined in the option below.I do not plan to purchase travel insurance at any time. I decline to purchase travel insurance. I understand that I am solely responsible for any cancellation penalties and out-of-pocket expenses which may be incurred. I will 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 for the trip described above. I understand I am solely liable for all airline fees, supplier fees, and agency fees that may apply. I am also aware that all payments to Crowning Touch Travel, LLC / Crowning Touch Travel, LLC dba Diva Escapes and dba Gent Journeys are non-refundable and non-transferrable. I hereby release Crowning Touch Travel, LLC / Crowning Touch Travel, LLC dba Diva Escapes and dba Gent Journeys and its agents from any and all liability related to the trip described above.I have purchased travel insurance and my policy information is indicated below. If, selected, please include the policy info below.
Policy #
Policy Carrier
Minor Children Covered by Waiver
1. Minor or other person under your care this Travel Insurance Waiver covers:

First NameMiddle NameLast NameSuffix
Minor's Date of Birth

MonthDayYear
2. Minor or other person under your care this Travel Insurance Waiver covers:

First NameMiddle NameLast NameSuffix
Minor's Date of Birth

MonthDayYear
3. Minor or other person under your care this Travel Insurance Waiver covers:

First NameMiddle NameLast NameSuffix
Minor's Date of Birth

MonthDayYear
If you wish to purchase a travel insurance plan through any means (on your own or through agent), please purchase within 7-14 days of your trip deposit based on the insurance carrier terms if you wish to include coverage for pre-existing conditions and supplier default conditions.

I have read this document and I affirm my understanding of this document and all consequences resulting from my decision to purchase on my own or decline travel insurance. I understand I am solely liable for all airline fees, supplier fees, and agency fees that may apply. I am also aware that all payments to Crowning Touch Travel, LLC / Crowning Touch Travel, LLC dba Diva Escapes and dba Gent Journeys are non-refundable and non-transferrable. I hereby release Crowning Touch Travel, LLC / Crowning Touch Travel, LLC dba Diva Escapes and dba Gent Journeys and its agents from any and all liability related to the trip described above.
Name*

First NameMiddle NameLast NameSuffix
Signature*
Date*

MonthDayYear
Should be Empty:

TRAVEL INSURANCE WAIVER

Minor Children Covered by Waiver