Toll Free: 1-(844)-5-PANAMA|info@panamaconcierge.com

Ver en Español

Home
All-Inclusive Packages
Accommodations
- Best Deals
- Bocas del Toro
Why Panama?
Contact & More

Home
All-Inclusive Packages
Accommodations
- Best Deals
- Bocas del Toro
Why Panama?
Contact & More

Release of Liability Jack Pichard 2016-01-08T01:56:36+00:00

Release of Liability

Group Information

Bachelor's Last Name (Group Name) *

Participant's Information

First Name: *

Middle Initial:

Last Name: *

Date of Birth: *

E-mail Address: *

Street Address: *

City: *

State / Province: *

Postal / Zip Code: *

Country: *

Primary Phone: *

Secondary Phone:

Emergency Contact Information

Emergency Contact #1: *

Relationship: *

Phone #: *

Emergency Contact #2: *

Relationship: *

Phone #: *

Please read each section carefully. If you agree and accept each provision please check the box that follows each section:

1. I am aware of the nature of the group tour and wish to participate in this event. *

Yes, I Agree

2. At all times I agree to follow any rules established by Panama Concierge, their officers, employees, agents, while on the Tour. *

Yes, I Agree

3. When you participate in a Tour of this nature there are always risks and hazards of personal injury, sickness or death. These risks and hazards include, but are not limited to failure of equipment, sudden change in conditions, error in judgment of participants, the contraction of disease, sickness or infection; falling, and all other hazards associated with the activities offered on the Tour. I agree to assume all these risks and hazards and indemnify, save and hold harmless, Panama Concierge, John Pichard, Frederick Robbins, their officers, employees, agents from all personal liability resulting from acts I have undertaken while on the Tour. *

Yes, I Agree

4. When you participate in a Tour of this nature there are always risks and hazards of and property damage or loss. If anything happens to myself or to my property while participating in any activity on the Tour, I agree to NOT hold Panama Concierge, John Pichard, Frederick Robbins, their officers, employees, agents for any damage or loss. *

Yes, I Agree

5. I realize I am solely responsible for obtaining adequate baggage/property insurance for the time I am on the Tour. *

Yes, I Agree

6. In an emergency I may need medical care or surgical treatment. If an emergency occurs and I am unable to give any instructions to medical personnel, I consent to my emergency medical treatment. I agree that I will be financially responsible for the cost of any emergency medical treatment. In the event that Panama Concierge is unable to contact my emergency contact person, Panama Concierge may also make any other decisions that are necessary in a medical emergency. *

Yes, I Agree

7. To the best of my knowledge, I am physically fit and able to participate in the activity or event, and I have no special medical needs and if so, I will inform Panama Concierge of those needs in a timely manner. *

Yes, I Agree

8. I agree that the terms of this agreement will constitute a complete release of liability for Panama Concierge, John Pichard, Frederick Robbins, their officers, employees and/or agents. *

Yes, I Agree

9. The provisions of this document are binding on myself my heirs, executors, administrators, personal representatives and assigns. *

Yes, I Agree

Please type your full name into the space below. This is the equivalent of your official electronic signature that the above information is true and correct

Sign Here: *

Today's Date: *

Accept Terms: *

I HAVE READ THIS RELEASE AND INDEMNITY AND ACCEPT ITS TERMS.

Find Us on Facebook!

Follow us on Instagram

This error message is only visible to WordPress admins

Error: No feed found.

Please go to the Instagram Feed settings page to create a feed.

@panamaconcierge

Recent Tweets

Contact Us

Name *

Email *

Phone Number *

Message *

How Did You Hear About Us?

reCAPTCHA

Facebook Twitter Google+