Medical Waiver and Acknowledgement of Risk Form
Please complete the following medical waiver and acknowledgement of risk form.
Participant's Full Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Physical and Mental Health Medical Condition(s)
Note: This information is kept confidential and is only used to support your health and safety during the tour.
Medications
Note: This information is kept confidential and is only used to support your health and safety during the tour.
Physical limitations or mobility issues relevant to activities
IMPORTANT: Your safety and wellbeing is a priority. A reasonable level of health and fitness is required for this tour. There are a number of early morning starts and it gets hot during the day. If you have blood pressure, heart or kidney issues, or have difficulty walking short distances, please check with your medical adviser before registering. While the trip is paced to allow adequate time for rest and relaxation.
Emergency Contact Name
*
First Name
Last Name
Emergency Contact Phone
*
Please enter a valid phone number.
Acknowledgment of Risk & Liability Release
Acknowledgment of Risk & Liability Release - I understand that participation in this tour involves inherent risks, including but not limited to injury, illness, death or loss. I voluntarily assume all such risks. I release and hold harmless Judy Satori global, its staff, volunteers, and affiliates from any liability, claim, or cause of action arising from participation in the tour.
*
I have read, understand, and agree to the above consent and acknowledgment of risk.
Emergency Treatment Authorization
Emergency Treatment Authorization - In the event of a medical emergency, I authorize Judy Satori or the tour support team to seek medical treatment on my behalf. I understand that I am responsible for any medical costs incurred.
*
I have read, understand, and agree to the above consent and acknowledgment of risk.
Consent & Acknowledgment of Risk
I acknowledge that my participation in the Judy Satori Egypt Tour involves inherent risks, including but not limited to illness, injury, death or physical strain related to activities, travel, or accommodations. I confirm that I have disclosed any physical limitations or mobility issues that may affect my participation. By checking the following boxes, I understand and accept that:
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Participation is voluntary and I do so at my own risk
I am responsible for my own health and wellbeing during the trip
Should I become ill, sustain an injury, or otherwise be unable to participate, I will not be entitled to any refund of deposits or payments
If the trip is shortened, modified, or canceled for any reason, including my inability to participate due to health or physical limitations, I waive any claim for reimbursement
I release Judy Satori Global, its staff, volunteers, and affiliates from any liability related to illness, injury, or inability to participate, and I accept full responsibility for my decision to participate.
I acknowledge that it is my responsibility to obtain comprehensive travel insurance to cover medical expenses, trip cancellations, delays, or other unforeseen events. I understand that travel insurance may mitigate or reduce potential costs associated with illness, injury, or changes to my trip. I agree that Judy Satori Global is not responsible for any financial losses incurred if I do not have adequate coverage.
I have read, understand, and agree to the above consent and acknowledgment of risk.
Participant's Signature
*
Submit
Submit
Should be Empty: