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Private Leisure July 2022: CHILE22 12D11N
Rated 2.99 out of 5
$5,200.00 Select options

All Applicants Must Fill Out The Travel Application

Ready to book a trip of lifetime? Just make a first deposit as little as $100 and start planing your adventure to Peru. If you are not sure, and would like to contact us, please don’t hesitate to email us your questions at: roybbenites@gmail.com and we wil be contacting you shortly.
Download Travel Application
Or Fill Out Form Below

Travel Application

Name *
Phone Number
Email *
Address (Mailing) *
City *
ZIP *
State *
Are you an existing customer? YesNo
How did find out about this event?
Comments or Questions

Personal Information

Birthday
Passport #
Exp. Date
Gender MaleFemale
Languages

DEPOSITS & PAYMENT PLAN

An initial $500 deposit is required to participate in one of the trips with EXPLORE Peru Payment plan are available, and it runs until 60 days prior the departure, the participant can enroll to a payment plan without extra fees and doesn’t need to pay for their trip all at once. All major credit cards from Visa, Mastercard, American Express are accepted, to avoid the 3.75% credit card fees, please consult the electric transfers options and Apps available: Venmo, PayPal, CASH by Square or send a personal check to:
EXPLORE Peru 11175 South O’henry Rd, Sandy UT 84070 REGULATION AND CONDITIONS:

Before I can participate, required forms and payments must also be submitted.

I will be flexible, patient, and foremost, keep a sense of humor. I understand that the Tour Leader will give their best efforts and will need my support. I will also abide by the code of conduct requiring exemplary behavior and consideration for others.

Insurance and risk: I am responsible for my health and belongings; travel insurance is not included in the cost of the trip and it is up to me to determine the sufficiency of my insurance. EXPLORE Peru is not responsible for the cost of medical care or any loss/damage incurred during or as a result of this expedition.

Cancelations: Once the deposit is submitted along with this form, should I decide not to go for any reason, all booked airline tickets and any other booked fees paid by EXPLORE Peru for travel become partial non-refundable. To the extent that deposits have not been spent and/or refunds can be obtained, EXPLORE Peru upon request will refund the funds, less any penalties incurred by the Peruvian provider services. Full payment is due at least 60 days prior to departure, unless notified otherwise. Funds become nonrefundable at that time.

In-country cancellations as a result of disruptions, which are out of EXPLORE Peru control, are non-refundable at any time.

Once I have been accepted as a participant of the trip, I understand I need to read the expedition Itinerary given to me and attend any coordination meetings organized by the Tour Leader. It is my responsibility to complete and to submit the travel application.

Emergency Contact Information

Contact Name
Relationship
Address
City, State, ZIP
Phone Number
Email
In case of an emergency, I understand that I am responsible for my own health and care, including evacuation if necessary.

Health Insurance Information

Health Care Provider
Policy Holder Name
Account Number
Provider phone # (24 hour # if possible)

Personal Health History

Check if you have or have had any symptoms in the following areas to a significant degree and briefly explain.

Anxiety
Asthma
Bladder/ Kidney Problems
Blood Clot
Cardiac/Heart Problems
Cancer
COPD/Pulmonary Problems
Circulation
Kidney Stones
GI/Stomach Problems
Hypertension
Liver Disease
Migraine Headaches
Diabetes
Stroke
Seizure Disorder (Epilepsy)

Explain reason for marking any of the listed items above:

Immunizations and dates

Tetanus
Chicken Pox
Pneumonia
Influenza
Hepatitis A
Hepatitis B
MMR

Have you tested positive for TB and if so, when? YesNo
TB Test Date

Have you ever had a blood transfusion? YesNo

Responsibility & Liability

EXPLORE Peru shall not be liable for any death, nor for any damages or claims arising from negligence of any person. I do for myself, my heirs, executors, and administrators, release and forever discharge EXPLORE Peru, and all other persons or legal entities connected in any way or manner with, acting officially or otherwise, from all claims, demands, actions, or causes of action, on account of my death or on account of any injury, sickness or otherwise, which may occur to me from any cause during this trip or any continuation of it or resulting from it. I further agree that I will not sue, seek to sue, or make any claim for any damages whatsoever, for anything which is related, however remotely, to this trip, against EXPLORE Peru or any other person or legal entity connected in any manner with the Peru Expedition.

I agree to the terms and conditions as presented above
Sign (ALL CAPS)
I confirm my child (under 18 years old) is able to attend.
Legal Guardian Sign (ALL CAPS) if under 18

* Required

Close Travel Application

Ready to book a trip of lifetime? Just make a first deposit as little as $100 and start planing your adventure to Peru. If you are not sure, and would like to contact us, please don’t hesitate to email us your questions at: roybbenites@gmail.com and we wil be contacting you shortly.

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