Travel Waiver, Release of Liability & Pre-Arrival Questionnaire
Full Legal Name as Shown on Passport
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First Name
Last Name
Nationality
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Date of Birth
Legal Date of Birth
MM
DD
YYYY
Dietary Requirements/Allergies
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Medical Conditions the FJS Team Needs to Know Of
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* (Seizure disorder, severe allergies, heart condition, diabetes, pregnancy, taking anti-coagulant medications, etc.) *
NOTE: Full discretion of any conditions or needs will always be maintained by the FJS team.
Flight (Arrival/s)
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Please include the following information regarding your airline travel to Africa:
Arrival Flight Details, Arrival Time & Date, Arrival Airport, Airline, Flight #
Flight (Departure/s)
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INCLUDE ANY OTHER FLIGHT TRAVEL THROUGHOUT YOUR TRIP HERE.
Please include the following information regarding your airline travel to Africa:
Departure Flight Details, Departure Time & Date, Departure Airport, Airline, Flight #
Email
Home Address
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This should be your legal place of residence
Passport Date of Issue
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MM
DD
YYYY
Passport Date of Expiration
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MM
DD
YYYY
Passport Number
Include full passport number and any letters
Special Requests/ Travel Needs
Please include anything the FJS team may need to know to ease your travel.
Information Verification
I verify the above information is legally correct. Forrest James Detwiler will not be responsible for omissions or errors if not brought to my attention immediately.
Passport Agreement
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I hereby verify and understand that I have been officially informed that U.S. citizens traveling to any destination outside of the United States will be required to present a valid U.S. passport. Passports must be valid for 6 months past the return date. Some countries require a visa for transit or entry. Passengers are responsible to ensure that they have all the proper documents for entry. All names on documents must match the legal name on your photo I.D., and travel document information must match tickets. Please check the State Department website at https://travel.state.gov for further information. Immunizations may also be required. Failure to comply with these regulations may result in denied boarding, denied entry, and/or government-imposed fines. If you are a citizen of another country, there may be additional requirements. Check with the nearest consulate or embassy of the destination you are traveling to and find out the entry requirements for non-U.S. citizens. *
Travel Vendor Agreement
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I understand and verify that FORREST JAMES SAFARIS LLC offers retail travel services to customers, which are provided by separate and independent vendors of travel services. FORREST JAMES SAFARIS LLC does not operate, control, or otherwise provide the services of the independent travel vendors. Hence, customer agrees that FORREST JAMES SAFARIS LLC acts only as agent for the client in acquiring transportation, hotel accommodations, sightseeing, and other privileges, or services for the clients’ benefit, and on the express condition that FORREST JAMES SAFARIS LLC and the owner/operator Forrest James Detwiler shall not be responsible for any loss, accident, injury, delay, defect, omission or irregularity which may occur or be occasioned, whether by reason of any act, negligence or default of any company or person engaged in or responsible for carrying out any of the arrangements, or otherwise in connection there with.
Travel Insurance Agreement
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We here at FORREST JAMES SAFARIS LLC recommend all of our clients purchase some form of international travel insurance before their departure from their country of origin. I assume and understand that there is a risk involved with my travel and my travel activities and/or excursions. I acknowledge that I was informed about my options by FORREST JAMES SAFARIS LLC but I declined the insurance.
Risk and Liability Agreement
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In consideration of being allowed to participate in any activity or travel with FORREST JAMES SAFARIS LLC, the undersigned acknowledges, appreciates, and agrees that:
the risks of personal illness and injury from the activities involved in this program are present, up to and including death. While rules and personal discipline may reduce the likelihood of occurrence, the risk of serious illness and injury up to and including death do exist; and I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES or others and assume full responsibility for my participation. I willingly agree to comply with the stated and customary terms and conditions for participation. I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE AND HOLD HARMLESS FORREST JAMES SAFARIS LLC, owner and operator Forrest J. Detwiler, any and all employees, agents, and/or contracted or subcontracted employees, other participants, sponsoring agencies, sponsors, advertisers, and if applicable, owners and lessors of premises used to conduct the event or travel (“RELEASEES”), WITH RESPECT TO ANY AND ALL ILLNESS, INJURY, DISABILITY, DEATH, or loss or damage to person or property, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE, to the fullest extent permitted by law.
Final Terms
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I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.
Name
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First Name
Last Name
Date of Form Completion
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MM
DD
YYYY
