Travel Insurance Waiver

Travel Insurance Waiver
I have been offered and advised of travel protection / trip insurance options and fees by my travel agent, Jhenell Douglas-Clarke.
List price of insurance/Provider
*Example: Carnival Vacation Protection, Aliianz, AIG, etc
Do you have your own travel insurance?
If yes, List Travel insurance and policy number
If No, Reason for Decline of insurance.
Departure

MonthDayYear
Date
Return

MonthDayYear
Date
Booking/Confirmation#
Total Trip Cost
I decline the offer to purchase travel protection / trip insurance. 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 described above. I understand I am solely liable for all airline fees, supplier fees, and agency fees that may apply, and I hereby release Absolute Escape, and its affilate Inteletravel from any and all liability related to the trip described above.
List of Travelers that also decline Travel Insurance
I have read this document. I understand this document and all consequences resulting from my decision to purchase or decline trip protection and trip insurance.
Date

MonthDayYear
Date
Signature
Should be Empty: