Travel Insurance Opt-In/Opt-Out Waiver
Full Name
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First Name
Last Name
Email Address
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Phone Number
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Format: (000) 000-0000.
Vacation Destination
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Vacation Cost
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Return Date
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Month
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Day
Year
2 digit month, 2 digit day, 4 digit year
Departure Date
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Month
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Day
Year
2 digit month, 2 digit day, 4 digit year
Insurance cost
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Recommended by GetAway Dreams by Agent Tara Hilbert
Do you wish to opt-in for travel insurance coverage for your trip?
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Yes, I wish to opt-in for travel insurance coverage to protect my trip investment.
No, I wish to opt-out of travel insurance coverage. I understand the financial risks.
Acknowledgment of Risk: I acknowledge that my travel advisor has strongly recommended and offered travel insurance to protect my trip investment against unforeseen events like trip cancellation, medical emergencies, evacuation, or supplier default. Financial Responsibility: "I understand that by declining coverage, I am solely responsible for any cancellation penalties, out-of-pocket medical expenses, or losses incurred. Many travel suppliers enforce strict, non-refundable cancellation policies. Release of Liability: I hereby release GetAway Dreams by Tara and my travel advisor Tara Hilbert from any and all financial liability or claims resulting from my decision to decline travel insurance.
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Signature
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Today's Date
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Month
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Day
Year
2 digit month, 2 digit day, 4 digit year
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