TRAVEL LIABILITY WAIVER AND RISK ACKNOWLEDGEMENT FORM - INDONESIA

Description of Trip: Shopping tour to Indonesia including but not limited to Bali, Denpasar, Lombok, Jakarta and other surrounding villages. The tour will include activities such as sightseeing, shopping, hiking, walking, boat excursion.

Dates of Trip: TBD (includes time for shipment of any purchases)

Coordinators of Trip: This trip is coordinated by The Caravan Gallery of La Conner and its owner, Linda Banaszak, Traveling Shoppers and its owners Linda Banaszak and Danielle Hill, Terry Divyak and Shutter Tours LLC.

Travel to Indonsia: I acknowledge that I am responsible for making all travel arrangements from the United States to Denpasar, Bali and Denpasar, Bali to the United States. I understand that The Caravan Gallery of LaConner, Traveling Shoppers, Linda Banaszak, Danielle Hill, Terry Divyak, and Shutter Tours LLC are not responsible for assuring the safety and reliability of such transportation.

Risk of Physical Injury:I understand that participation in Trip activities could involve risk of physical injury, illness, death or property loss, and despite safety precautions, the coordinators cannot guarantee safety thereof, as all risks cannot be prevented. I certify that I am physically fit, have sufficiently prepared or trained for participation in Trip, and have not been advised to not participate by a qualified medical professional. I certify that there are no health-related reasons or problems which preclude my participation inTrip.

Risk of Medical Expense:The coordinators do not provide health or accident insurance for Trip participants. I understand that any medical expenses, property loss, or other personal expenditures that result during or from Trip, are to be borne by me.I also hereby consent and give authorization to The coordinators to secure any emergency medical treatment in event I am unable to, and I agree to be responsible for the costs thereof.

{I certify that I have purchased a travel insurance policy through <insert company name here> valid the dates of February 10 through March 1st, 2025)}

With full knowledge and acceptance of the risks associated with this travel and theTrip activities, and with full understanding of the above conditions,I hereby release, indemnify and hold harmlessThe Caravan Gallery of LaConner,Traveling Shoppers, Linda Banaszak, Danielle Hill, Bryan Hill, Terry Divyak, Shutter Tours LLC and any agents of the company from all form and manner of risks inherent in such travel, and from all claims and demands of any nature arising from participation in Trip, event, or function. This Travel Liability Waiver and Risk Acknowledgement form shall be construed broadly to provide a release and waiver to the maximum extent permissible under applicable law.

I WAIVE, RELEASE, AND DISCHARGE from any and all liability, including but not limited to, liability a rising from the negligence or fault of the entities or persons released, for my death, disability, personal injury, property damage, property theft, or actions of any kind which may hereafter occur to me including my traveling to and from Trip, THE FOLLOWING ENTITIES OR PERSONS:The Caravan Gallery of LaConner,Traveling Shoppers, Linda Banaszak, Danielle Hill, Bryan Hill, Terry Divyak, and Shutter Tours LLC and/or their directors, officers, employees, volunteers, representatives, and agents. INDEMNIFY, HOLD HARMLESS, AND PROMISE NOT TO SUE the entities or persons mentioned in this paragraph from any and all liabilities or claims made as a result of my participation inTrip. I acknowledge thatThe Caravan Gallery of LaConner,Traveling Shoppers, Linda Banaszak, Danielle Hill, Bryan Hill, Terry Divyak, and Shutter Tours LLC, and their directors, officers, volunteers, representatives, and agents are NOT responsible for the errors, omissions, acts, or failures to act of any party or entity conducting a specific activity on their behalf during Trip.

ARBITRATION: I agree that any dispute concerning, relating to, or concerning Trip shall be resolved exclusively by binding arbitration according to the then existing rules of the American Arbitration Association in the State of Washington. Such proceedings will be governed by and in accordance with substantive Washington state law. The arbitrator and not any federal, state, or local court or agency shall have exclusive authority to resolve any dispute relating to the interpretation, applicability, enforceability, conscionability, or formation of this contract, including but not limited to any claim that all or any part of this contract is void or voidable.

I CERTIFY THAT I HAVE READ THIS DOCUMENT AND I FULLY UNDERSTAND ITS CONTENT. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY AND I SIGN IT OF MY OWN FREE WILL.

Signature of Participant: ____________________________________Date: ____________

Emergency Contact Name:___________________________________Phone:____________