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El Mundo Magico Liability Release for the expedition to the Q'eros Indians
By joining a trip facilitated by
El Mundo Magico all participants are bound by the terms and conditions of the
present waiver of liability.
Privacy Note
Please print and fill-in the form below.
Please return - by "signed for"/registered mail service - the completed, printed form below to: El Mundo Magico
Flat 5, 8 Queen's Road, Lexden, Colchester CO3 3NP, Essex, United Kingdom
Tel/Fax: 01206 710 615 (from the UK) - Tel/Fax: + 44- 1206 710 615 (from Abroad)
Email: El Mundo Magico (info@elmundomagico.org),
El Mundo Magico - Registered in England, 21 September 2000, N. 4076005
Terms and Conditions, waiver of all claims, release from liability and assumption of risks for the Q'eros Expedition |
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El Mundo Magico
L
You agree that El Mundo Magico Ltd shall not be liable for any loss, injury, or damage to person, property or otherwise in connection with any accommodations, transportation or other services resulting directly or indirectly from causes of force majeure, including but not limited to dangers incident to water, air or earth, fire, breakdown in machinery or equipment, acts of governments or other authorities, dejure or de facto, strikes, riots, criminal activity, thefts, pilferage, epidemics, quarantines, medical or customs regulations.
The participant must be in a physical and mental condition appropriate to the activity. He/she must acknowledge all the potential physical and mental risks involved and agree to participate at his/her own risk. The responsibility of taking accurate and timely health precautions - alongside professional medical advice - remains entirely with the undersigned.
The participant is expected to show
respect at all times towards ceremonial practices and
THE UNDERSIGNED HEREBY RELEASES, WAIVES, DISCHARGES AND COVENANTS NOT TO SUE El Mundo Magico Ltd, its representatives, associates, directors or employees (hereinafter referred to as 'releasees') from all liability to the undersigned for any loss or damage and any claim or demands therefore on account of injury to the person or property or resulting in death of the undersigned, whether caused by the negligence of the releasees or otherwise. HE/SHE FREELY ACCEPT AND FULLY ASSUME ALL SUCH RISKS, AND HAZARDS AND THE POSSIBILITY OF PERSONAL INJURY, DEATH, PROPERTY DAMAGE OR LOSS RESULTING THEREFROM. THE UNDERSIGNED further expressly agrees that the foregoing RELEASE, WAIVER AND INDEMNITY AGREEMENT is intended to be as broad and inclusive as is permitted by the law of England and Wales and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect.
THE UNDERSIGNED HAS
READ AND VOLUNTARILY SIGNS THE RELEASE AND WAIVER OF LIABILITY AND INDEMNITY
AGREEMENT, further agrees that no oral representations, statements or inducement
apart from the foregoing written agreement have been made and
I, …………………………………………………………..(print name) have read the terms and conditions of participating to this expedition to the Q'eros Indians facilitated by El Mundo Magico.
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First Name(s):
.....................................................................................
Family Name(s):
Title (e.g. Dr, Mr, Miss, Mrs, Ms):
Date and place of birth:
Nationality
Age:
Occupation:
Tel:
Fax:
Email:
Secondary Email address:
Home Address:
City:
Postal Code/ZIP
State/Country:
Are you presently on any long term medication?
If yes, name of medication, and for what condition:
Known physical or medical limitations?
Do you suffer, or have ever suffered, from altitude sickness?
Do you suffer from hypertension?
Do you have an history of asthma or emphysema?
Do you have any other respiratory disease?
Do you suffer from diabetes? Do you use insulin or medication?
Do you suffer from Reynaud's disease?
Do you ever had an heart attack?
Known drug allergies:
Contact in case of emergency
Name:
Tel:
Fax:
Email:
Your Passport Number and
Country of issue
Your Name as it appears on the Passport:
I attest that all the information is true and provided voluntarily.
Signed:
Date:
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