Liability Waiver

Liability Waiver
Your Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Email*
example@example.com
Phone Number*

Country CodeArea CodePhone Number
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Passport Number*
Passport Country*
Expiration Date*

MonthDayYear
Date
Please list any allergies, medical conditions/needs, or special dietary needs. Write N/A if none.*
Emergency Contact

Cannot be an individual coming on the trip.
Name*

First NameLast Name
Relationship*
Email*
example@example.com
Phone Number*

Country CodeArea CodePhone Number
I will be responsible for minors on this trip.*

YesNo
Minor 1 Name

First NameLast Name
Minor 2 Name

First NameLast Name
Minor 3 Name

First NameLast Name
I understand that The Olmalaika Trust & African Springs Safaris Ltd cannot be held liable for theft, injury, accident, death, loss, or sickness occuring during this trip. By signing below, I am agreeing that I understand the risks involved in travel and that I will not hold these organizations nor their employees responsible if something goes wrong.

I understand that if I cancel 35 days or less before the trip begins, all funds not already in use for the trip, will be used for Olmalaika Trust projects.

*Any minors listed are included in this agreement
Your Signature*

Clear
Should be Empty:

Emergency Contact