2013 trip contact form

2013 Costa Rica Trips: Info & Emergency Contact Form

* Indicates required field

Name *

First

Last

Address *

Line 1

Line 2

City

State

Zip Code

Country

Email *

Phone Number *

Date of Birth *

Passport # / country of origin *

Health Insurance Provider/Carrier *

Health Insurance Policy Number *

Health Insurance Provider/Carrier Telephone Number *

In case of emergency, please contact (specify relationship): *

Emergency contact’s telephone number: *

Do you have any allergies? If so, specify: *

Any Medications you are taking, including dosage: *

Dietary Restrictions *

On a scale of 1-10, with 10, being very active, how would you rate your physical activity level? *

On a scale of 1-10, with 10, being very experienced, how would you rate your experience with:

Walking/Hiking *

Cycling *

Horseback riding *

Whitewater rafting *

Snorkeling *

Swimming *

Anything else Greener Travel should know about your health, dietary restrictions, activity level, or other concerns? *

I have read and understand the Greener Travel Company policies below (please initial) *

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Greener Travel Company, LLC Policies for Costa Rica individual tours

RESERVATION AND BOOKING

Reservation and Deposit: We usually requite a deposit of 20% upon booking a trip.

Full Payment: Full payment must be made at least 5 weeks prior to the trip departure date.

Possible Delays and Trip Insurance: We strongly encourage all of our travelers to purchase trip insurance. Greener Travel is not responsible for airline delays and cancellations and in most cases will NOT be able to offer refunds for travelers who miss all or part of their tour due to airline delays and cancellations. Some suggestions are Travelex and Travel Guard.

Method of Payment: We accept payment by check or Stripe. We offer an additional discount of 2.9% for payment by check for travelers registering sufficiently in advance of the departure date. Please make checks payable to:

Greener Travel LLC.
1742 Kalorama Rd. NW
Unit B
Washington, DC 20009
USA

CANCELLATION AND REFUND

Cancellation by You and Refunds: If you cancel your trip anytime after booking it will have to keep 15% of the cost of the trip to cover our costs. We we will do our best to refund you the remaining cost of the trip, though this depends on the many guides, hotels, transportation and activity partners we work with - in general, the closer it gets to the date of the trip, the less we will be able to refund you. For this reason, we STRONGLY encourage you to purchase travel insurance: some suggestions for such insurance are Travelex and Travel Guard.

Cancellation of individual activities or change of itinerary: Due to weather or other reasons, you or the travel providers we work with may need to cancel an activity. If a provider cancels an activity, we will refund the entire cost of that activity, and/or do our best in finding an alternative activity for you, without applying any processing charges or other fees. If you wish to change or alter your itinerary during your trip, you will need to contact us during the trip and we will do our best to change the itinerary - which will ultimately depend on the partners we work with in Costa Rica.

ACKNOWLEDGEMENT AND ASSUMPTION OF RISK; WAIVER OF LIABILITY

Acknowledgement and Assumption of Risk; Waiver of Liability: You acknowledge that travel includes a variety of known and unanticipated risks, which could result in injury, paralysis, or death, or damage to property. You acknowledge that those risks may be created by negligence of Greener Travel, its owners, employees, contractors, and agents, other travelers of Greener Travel, and third party providers over whom Greener Travel has no control, as well as weather and natural disasters. You agree to accept and assume all risks existing in this activity, and to release, forever discharge, and agree to indemnify and hold harmless Greener Travel from any and all claims, demands, or causes of action, which are in any way connected with my participation in our trips, including any such Claims which allege negligent acts or omissions of Greener Travel. Should Greener Travel or anyone acting on their behalf be required to incur attorney’s fees and cost to enforce this agreement, you agree to indemnify and hold them harmless for all such fees and costs.

FITNESS FOR TRAVEL AND HEALTH INSURANCE

Fitness for Travel: It is your responsibility to determine that you are capable of participating in all of the activities offered on this trip and to opt out of any activities that you are not able to participate in due to your abilities (ie, ability to swim, etc.), disability, or any medical conditions.

Travel Health Insurance: We strongly encourage travelers to purchase travel health insurance to cover any medical events or emergencies that occur while you are on your trip. PLEASE NOTE THAT TRAVEL HEALTH INSURANCE AND TRAVEL INSURANCE ARE NOT THE SAME THING—Travel insurance covers the cost of your trip in the event of travel delays or your need to cancel the trip. Travel health insurance is a health insurance policy that covers your medical costs in the event of illness or injury overseas. Following is a suggested link that allows you to compare between different options and purchase the insurance online.

USE OF IMAGES

You agree that any images, including photographs and videos, of you taken during the trip, and that you choose to share with us, may be used by Greener Travel at no charge for commercial purposes.

CONSENT TO JURISDICTION, WAIVER OF REMEDIES

You also agree that any dispute concerning Greener Travel’s services will be determined by the courts in the District of Columbia and consent to jurisdiction in those courts. You agree that if you have any dispute regarding Greener Travel’s services, you will present a claim to us in that regard within 2 months of travel, and will not file an action more than 9 months after the completion of travel. Should you accept a payment or refund of any amount in the event of a dispute, you agree to waive any other rights and remedies you may have under applicable law. In no event will Greener Travel be liable for any costs above the amount paid by you to Greener Travel.

You will be asked to fill in several waivers for some of the other activities we will be doing on the trip: zipline adventure, hot springs, rafting/boating, snorkeling. These waivers will be provided by the proprietors of those activities.