Insurance Waiver Form

Insurance Waiver Form

Including trip cancellation/interruption and medical coverage
I have been offered and advised of travel protection/trip insurance options and fees by my Travel Advisor, Page Ramirez.*

YesNo
Have you purchased travel insurance for this trip from another third party?*

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Name*

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Departure Date*

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Date
Return Date*

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Date
Type a question

I am signing as the legal parent or guardian of a minor under the age of 18.
I acknowledge and agree that I have been offered travel insurance by Travel Advisor, Page Ramirez, and have declined to purchase travel insurance. This can include but is not limited to: travel cancellation & interruption, emergency medical transportation, emergency medical expense coverage, and lost or damaged baggage & personal effects. I have read this document and understand all consequences resulting from my decision to decline trip protection and trip insurance. I understand I am solely liable for all airline fees, supplier fees, and agency fees that may apply, and I hereby release Memorable Adventures Travel from any and all liability related to the trip.
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Date*

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