Please give us your name.
Please give us your street address.
Please give us your city.
Please give us your state.
Please give us your Zip code.
Please give us a telephone number.
Please give us your email-address.
Please give us your date of birth.
Please give us your passport number.
Please give us your passport expiration date.
Please list all medical conditions or dietary restrictions you have that we need to be aware of.
Please give us the name of person to contact in the event of an emergency.
Please give us a telephone number for your emergency contact person.
ASSUMPTION OF RISK AND LIABILITY RELEASE AGREEMENT
Definitions - As used herein, “Hemispheres Unlimited” means “Hemispheres Unlimited, LLC and/or its destination and associate companies, their owners, shareholders, officers, agents or employees.” While Hemispheres Unlimited spares no effort in its attempt to provide its clients and staff with a safe travel environment, we frequently travel to remote locations where medical care may be minimal or nonexistent and where the terrain may be rugged and un-peopled. We expect our client will take reasonable and prudent care for their own safety and will recognize that Hemispheres Unlimited cannot guarantee anyone’s personal safety. For these reasons, we are only willing to provide you with the tour opportunity you have requested if you accept your personal responsibilities and release us from liability for your safety by entering into this Assumption Of Risk And Liability Release Agreement (hereinafter, the/this Agreement).
I UNDERSTAND THAT THIS AGREEMENT CONTAINS AN EXCULPATORY CLAUSE. I AGREE THAT HEMISPHERES UNLIMITED AND ITS OWNERS/EMPLOYEES, AS FURTHER EXPLAINED BELOW, ARE NOT LIABLE TO ME FOR ANY INJURY. I INTEND TO WAIVE MY RIGHT TO SUE HEMISPHERES UNLIMITED IN ADVANCE. I HAVE READ THIS CONTRACT IN FULL AND I AGREE TO ALL OF ITS PROVISIONS.
I have chosen to participate in recreational activities organized by Hemispheres Unlimited. I hereby acknowledge and agree that there are many obvious and non-obvious risks and dangers associated with activities around or concerning these activities. I recognize that risks of harm from using the guidance, equipment, facilities, services, watercraft, vehicles and/or other provisions of Hemispheres Unlimited exist. I also acknowledge that there may be other risks not known to me or that are not reasonably foreseeable at this time. I hereby expressly agree to assume all of the above risks and other related risks, known or unknown, which may be encountered by my use of the services, equipment, facilities, and guidance of Hemispheres Unlimited. Furthermore, in consideration of being permitted to use the premises, equipment, facilities, services, and guidance of Hemispheres Unlimited, I hereby release, waive, discharge and promise not to sue Hemispheres Unlimited, release them from all liabilities, claims, demands, responsibilities, causes of actions, or expenses (including, without limitation, judgments, attorney’s fees and court costs) arising out of or related to any activity undertaken during my trip, or my use of the premises, equipment, facilities, services, watercraft, and guidance, including, without limitation, any injury, death, or damage arising out of the negligence of the above named parties or otherwise. In further consideration of being permitted to use the premises, equipment, facilities, services, watercraft, and guidance of Hemispheres Unlimited, I hereby agree to indemnify, pay, protect, defend and hold harmless Hemispheres Unlimited from all losses, liabilities, damages or costs that I may incur arising out of or related to any activities on or around the Premises whether caused by the negligence of the Hemispheres Unlimited. I expressly agree that this Agreement is binding on my estate, heirs, administrators, next of kin and assigns. I agree that this Agreement is the entire agreement between me and Hemispheres Unlimited with respect to the subject matter set forth herein and that any modifications or changes to this Agreement must be in writing and signed by me and a representative of Hemispheres Unlimited. I also acknowledge that this Agreement is intended to be as broad and inclusive as permitted by the laws of the State of Delaware, the state of Georgia, the United States, and the locality of the destination respectively. I agree that if any portion of this Agreement is determined to be invalid or unenforceable, that part will be amended to achieve, as nearly as possible, the same effect as the original and the balance of the Agreement shall remain in full force and effect. This Agreement is executed in The United States of America and in the destination country/countries for the trip purchased. I represent and covenant to Hemispheres Unlimited that I have sufficient personal health, accident and liability insurance to cover injuries or property damage that I could sustain or cause while engaging in activities associated with my trip. I have read this release of liability, assumption of risk and indemnity agreement and I have fully understood its terms. I understand that I have given up substantial rights by signing it and have signed it freely and voluntarily without any inducement, assurance, or guarantee being made to me.
You must agree to the Assumption of Risk and Liability Release Agreement above to continue.