RESERVATION FORM
Each traveler must complete a copy of this form, carefully read the “Limits
on Panama Boutique™ Responsibility”, sign it and return the completed
form to the address or fax number shown on this page.
Tour Name: Departure Date:
Full Name:(as reads on Passport)
Telephone(s):
Address: __
Smoker __ Non-Smoker
E-mail:
Date of Birth:
Sex:
Weight:(only necessary when using chartered flights)
Nationality:
Passport #:
Passport Expiration Date:
Emergency Contact Name
Telephone & Relationship:
Special Requests/Medical
History/Dietary Requirements:
__________________________________________
__________________________________________
I wish to room with__________________________________
I prefer a single
room where available______
I would like to have a roommate Preferred type
of bedding: ____ One Bed ____ Two Beds
Form of Payment: ____ Check (payable to Panama Boutique) Amount: _____________
Credit Card: ___ MasterCard ___ Visa ___ AmEx ___ Discover
If paying by Credit Card, Panama Boutique™ will send you a link to Pay
Pal for payment processing.
Payment, in full or part, of the tour cost constitutes acceptance of the “LIMITS
OF PANAMA BOUTIQUE™ RESPONSIBILITY” set out in this document.
Signature of Traveler: __________________________________________Date:___________________
Signature of Parent or Guardian: ________________________________________Date:______________________
(Required for travelers under the age of 18, whether traveling with parent
or guardian or not)
Panama Boutique™
310 Le Grande Avenue
Austin, Texas 78704-1849
Mail with payment to address above
LIMITS ON PANAMA BOUTIQUE™ RESPONSIBILITY
Acts of God and the Like
PANAMA BOUTIQUE™ or the TRAVIS AUDUBON SOCIETY ARE IS NOT LIABLE for
acts of God, fire, acts of government or other authorities, wars, civil disturbances,
riots, terrorist acts, strikes, thefts, pilferage, epidemics, quarantines,
dangerous incidents at sea, land, and air travel, and OTHER SIMILAR ACTS OR
INCIDENTS BEYOND ITS CONTROL.
Traveler’s Representations
The traveler represents that neither he or she nor anyone traveling with him
or her has any PHYSICAL OR OTHER CONDITION OR DISABILITY that would create
a HAZARD TO HIMSELF OR HERSELF OR OTHERS participating on the tour.
Independent Suppliers
PANAMA BOUTIQUE™, a division of JB Journeys, LLC, purchases transportation,
hotel accommodations, restaurant services, and other services from various
independent suppliers that are not subject to its control. PANAMA BOUTIQUE™,
CANNOT, THEREFORE, BE LIABLE FOR ANY PROPERTY DAMAGE, PERSONAL INJURY OR DEATH
that may occur due to (1) any act or omission of such a supplier, or (2) defects
in or failures of any aircraft, vessel, automotive vehicle, or other means
of transportation that is not under its control.
Activities That May Be Dangerous
Activities will be available at some of the places you will visit. SOME OF
THESE ACTIVITIES CARRY WITH THEM THE INHERENT RISK OF SERIOUS PERSONAL INJURY.
These activities include, but are not necessarily limited to: (a) scuba diving;
(b) horseback riding; (c) canoe or kayaking; (d) white water rafting; among
others. You should be aware that YOUR PERSONAL SAFETY CANNOT BE GUARANTEED.
Should you elect to participate in such activities while you are on tour,
you are, of course, free to do so. However, you must understand that such
participation will be at your own risk and that PANAMA BOUTIQUE™ and
the TRAVIS AUDUBON SOCIETY ASSUME NO RESPONSIBILITY FOR YOUR SAFETY.
Under these terms, travelers under the age of 18 are required to have the consent of the parent or guardian whether they are traveling together or not.
Applicable Law
This agreement shall be construed, interpreted, and enforced in accordance
with, and shall be governed by, the laws of Travis County, Texas, USA.
RESERVATION AND CANCELLATION POLICY
Reservations:
To confirm a reservation we must receive a deposit of $500 per person at the time of booking a tour. The balance of the cost of the tour is due 90 days prior to the first day of the tour. (March 2, 2007)
Cancellations:
Cancellations made with more than 90 days notice from the first day of the tour are subject to a refund of the deposit less $100. Cancellations made within 90 days of first day of the tour are non-refundable. Name changes may be allowed. All cancellation requests must be done in writing.