Insurance Waiver Form

MM slash DD slash YYYY
Every Family or Party member over 18 years of age must be listed.
Passenger #1
Passenger #2
Passenger #3
Passenger #4
Passenger #5
Passenger #6

Types of Coverage Available

Trip Cancellation & Trip Interruption - Reimburses you for non-refundable payments and certain extra costs if your trip must be cancelled or interrupted due to injury, sickness, bankruptcy and default of an airline, tour operator or cruise line, or other specified circumstances.
Trip Delay - Pays for certain extra transportation and accommodation expenses if your trip is delayed for 6 hours or more.
Emergency Accident and Sickness Medical Expense - Covers you for Medical expenses incurred during your trip as a result of an accidental Injury which occurs or Sickness which first manifests itself during the Trip.
Baggage Loss - Reimburses you if your baggage is lost, stolen, or damaged while on your trip. This coverage is secondary to any coverage provided by a common carrier.
Baggage Delay - Reimburse you for the purchase of essential items if your baggage is delayed. Amount of time for the delay is based on plan purchased.
24-Hour Emergency Hotline Services - Provided by Travel Insured’s designated Assistance Provider
Travel Assistance - A source for all of your travel-related questions, from translation services to passport and visa information - even lost baggage and retrieval.
Lost Ticket & Passport Assistance - Assists in replacing lost or stolen passports and tickets.
Optional Flight Accident Plan - MUST BE PURCHASED BY ALL MEMBERS ON APPLICATION Covers you for injuries sustained while riding as a passenger in or on, boarding or alighting from an aircraft, or being struck or run down by an aircraft. Conditions, limitations and exclusions apply.
The options listed are available on certain plans. Check the plan brochure.

Waiver of Travel Protection

Please read this carefully!
I understand that Blue Ribbon Travel is not the source or supplier of the travel services I have requested, and acts solely as an agent for the actual suppliers of such services. I have been advised that the suppliers whose names appear in the information supplied to me are those who are actually responsible for providing the travel services I have purchased. I consent to and request the use of those suppliers and agree not to hold Blue Ribbon Travel responsible should any of these suppliers:
1) Fail to provide the travel services I have purchased.
2) Fail to comply with any applicable law.
3) Engage in any negligent act or omission that causes me any sort of injury, damage, delay or inconvenience.
I will review my travel documents for accuracy upon receipt and understand that I may contact Blue Ribbon Travel if I have any questions. I understand that discounted fares typically involve restrictions and that changing any aspect of my travel arrangements may result in the payment of additional money.
I have been advised to use a credit card as this may offer me the opportunity to dispute the charge should a vendor cease operating.
I understand that if traveling internationally, I must have a valid passport and depending upon my destination and nationality, I may need to obtain one or more visas.
Note to Client: Passport and visa information may be obtained by contacting the Travel Advisory Section of the U.S. State Department at 202.647.5225 or by visiting the State Department's Web site at www.state.gov. Non-U.S. passport holders should be sure to contact the embassies of their destination and transit countries to obtain entrance requirements. To obtain medical information, you may contact the Centers for Disease Control at 404.332.4559 or visit the CDC's Web site at www.cdc.gov.
I understand that I may purchase travel insurance to cover certain risks inherent in travel such as supplier bankruptcy and the inability to travel due to a medical or personal emergency. Please choose below whether or not you are interested in a Travel Protect Plan.

Election of Travel Protection Services(Required)
When selecting NO, we understand you have no interest in a Travel Protection Plan.