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Flight Information
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No
Group Name
Your Name
First
Last
Email
Destination Flight Information
Airline
Flight Number
Arrival Time
Home Flight Information
Airline
Flight Number
Departure Time
Vehicle Information
Are you part of a group?
Yes
No
Group Name
Your Name
First
Last
Email
Vehicle Registration Information
Rental Company Name
# of Vehicles
Type of Vehicle
Passport Information
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No
Group Name
Your Name
First
Last
Email
Upload an Image
Passport and/or Drivers License.
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Terms & ConDitions
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No
Group Name
Your Name
Email
Terms and Conditions Agreement
*
Deposit: A non-refundable deposit per participant is required.
Final Balance: Once a participant(s) is confirmed on a trip, the remaining balance is due no later than 30 days prior to scheduled departure date. If payment is not received by the final balance due date, your spot could be released, and your deposit will be forfeited.
Payments: Visa, MasterCard, Discover, American Express,
Personal Checks or Money Orders are accepted. All rates are in U.S. dollars. The rates are based on current tariffs and are subject to change due to unforeseen circumstances. While we will always try to maintain the listed prices, if it is necessary to levy a surcharge, we reserve the right to do so, and notification will be given at the time of final invoicing. We cannot be responsible for typographical errors, misprints, and misquotes. Payments via Wells Fargo Direct Deposit have no processing fee. Payments via online card processing systems such as PayPal and other systems will be charged the additional processing fees. By submitting payment of invoice, you acknowledge and agree to the terms and conditions of services.
Ground Inclusions: Participant trip cost include the following on-site provisions – Lodging/accommodations, ministry meals as indicated in the itinerary, project materials (unless indicated otherwise for larger projects), community outreach, Impact Adventure (IA) trip leader. Not included as part of the participant cost: vehicle rental and associated expenses (unless otherwise noted), free day meals outside lodging facility, free day excursions, sightseeing, etc. as noted.
Cancellation and Refund:
• 60+ days before departure: IA retains deposit per person.
• 59 days or less before departure: IA retains 100% of the trip cost.
• All refunds will be processed according to the manner in
which you paid.
• If you choose to leave your trip in progress for any reason, it
will result in the loss of your entire trip fees. No refunds will
be made for any unused portions of a trip.
• IA reserves the right to cancel any trip because of inadequate enrollment or legitimate concerns with respect to safety, health, or welfare of participants. If IA cancels a trip prior to departure, or if we cancel the trip in progress, you will receive a pro-rated refund based on the number of days not completed. IA will not be responsible for any refund from nonrefundable airline tickets or for any airline tickets
purchased by the passenger.
Travel Insurance: We strongly recommend trip cancellation/ interruption insurance for any foreign travel as situations may change, necessitating the postponement or cancellation of a trip.
Itinerary Changes: Itineraries and staff assignments are subject to modification and change by IA. Every reasonable effort will be made to operate programs as planned, but due to the nature of the projects and most current needs of our service partners, alterations may occur after final itineraries are sent.
Baggage Allowance and Liability: Passengers are responsible for paying additional charges for the baggage.
Suppliers Liabilities: IA might make arrangements with direct air carriers, hotels, tour companies, and other independent parties to provide you with travel services you purchase. These services are subject to the conditions imposed by these suppliers, and their liability may be limited by their tariffs, conditions of carriage, and international agreements.
Health: Participants are required to have sufficient personal travel medical insurance throughout your trip. It is the participants sole responsibility to arrange and determine any required immunizations and medical procedures that you may need before, during and after your IA trip. Responsibility of Impact Adventure (IA): This travel program is planned and operated by IA, as principal and tour operator. IA is responsible for making all arrangements for accommodations and services offered in connection with the package. This responsibility does not extend to any assumption of liability for any personal injury or property damage arising out of or caused by any hotel, air carrier, or anyone rendering services or accommodations being offered in connection with the package. IA will not be held responsible for liability from arrangements or services made outside of the trip. It is agreed, by and between the passenger and IA, that all disputes and matters whatsoever arising under, in connection with, or incident to this agreement shall be litigated, if at all, in and before a court located in Colorado U.S.A. to the exclusion of the courts of any other state.
Responsibility of Impact Adventure (IA): This travel program is planned and operated by IA, as principal and tour operator. IA is responsible for making all arrangements for accommodations and services offered in connection with the package. This responsibility does not extend to any assumption of liability for any personal injury or property damage arising out of or caused by any hotel, air carrier, or anyone rendering services or accommodations being offered in connection with the package. IA will not be held responsible for liability from arrangements or services made outside of the trip. It is agreed, by and between the
passenger and IA, that all disputes and matters whatsoever arising under, in connection with, or incident to this agreement shall be litigated, if at all, in and before a court located in Colorado U.S.A. to the exclusion of the courts of any other state.
Major Changes: If IA knows of some major change 10 or more days before a scheduled departure, you will be notified within seven days, but in any event at least 10 days before scheduled departure and otherwise as soon as possible.
Major changes are defined as:
1) A change in the departure or return dates shown in the brochure unless due to flight delays of less than 48 hours
2) A change in the origin or destination city
3) For any flight leg other than a change in the order in which cities are visited
4) Price increases amounting to more than 10%.
Time changes within the scheduled day of departure do not constitute a major change. Within seven days after receiving a pre-departure notice of a major change, but in no event later than departure, you may cancel, and a full refund will be made within 30 days after canceling. Upon a post-departure notification of a major change, you may reject the change and within 30 days after the scheduled return date will receive a refund of the portion of your payment applicable to the tour component not provided. All of your rights and remedies hereunder are additional to other rights you may have under law, but acceptance of any refund hereunder constitutes a waiver of all such other rights and remedies.
I agree to the Terms and Conditions.
Your Signature
*
Risk and Release Form
Are you part of a group?
Yes
No
Group Name
Your Name
Email
Risk Acknowledgement & Release Statement
*
The undersigned understands and acknowledges hereby being invited to participate with Mazatlán Missions DBA Impact Adventure, a Colorado nonprofit corporation, in certain travel activities in the location previously specified and for the timeperiod of the trip dates stated above.
The undersigned acknowledges that he or she has been informed of the risks that may result from such participation in the trip, including, but not limited to, acts of violence perpetrated upon the undersigned individually or in a group, kidnapping, piracy, hijacking, and/or the possibility of accident or disease. If construction work or physical labor is a component of the trip, the undersigned acknowledges that he or she has been informed of the risks that may result from such activities, including, but not limited to, physical injury resulting in impairment or death. The undersigned nevertheless has voluntarily chosen to participate
in and travel with Mazatlán Missions – Impact Adventure.
The undersigned further understands and acknowledges that it is his or her responsibility to obtain the necessary documents for entry into any foreign country, including, but not limited to, visas and passports; and to seek medical advice regarding any specialized pretreatment or treatment, medication or immunization that may be personally required for travel with Mazatlán Missions – Impact Adventure on the trip.
The undersigned understands that Mazatlán Missions – Impact Adventure works with many vendors and subcontractors including but not limited to lodging facilities, material suppliers, local agencies and churches.
The undersigned further acknowledges having had the opportunity to consult with legal counsel and with respect to rights and obligations under this Risk Acknowledgment and Release Statement and the legal effect thereof. Having been fully appraised of the risks, and in consideration of allowing the undersigned to travel with Mazatlán Missions – Impact Adventure on the trip: The undersigned hereby releases and covenants not to sue Mazatlán Missions – Impact Adventure employees, officers, directors, successors, assigns, heirs, personal representatives, agents and attorneys, with respect to all claims, demands, actions, or causes of action. Liabilities, judgments and executions which the undersigned may have, for all injury, including but not necessarily limited to: (1) Personal injury, disease, illness, accident, disability, death or other injury of any kind and (2) Injury or loss to property, real or personal, caused by or arising out of participation in or travel with Mazatlán Missions – Impact Adventure. If for whatever reason the undersigned is either individually or in a group involved in a kidnapping, piracy, or hijacking, the undersigned hereby agrees to allow Mazatlán Missions – Impact Adventure or its delegates to represent the undersigned and his or her family in any negotiation proceedings.
The undersigned agrees to conduct themselves in a manner consistent with behaviors specified in the Code of Conduct and other documentation provided by Mazatlán Missions – Impact Adventure.
The undersigned authorizes transportation by Mazatlán Missions – Impact Adventure representatives during the mission trip, and to receive professional healthcare if necessary.
The undersigned further authorizes Mazatlán Missions – Impact Adventure to use or disclose your protected health information for the purposes of treatment, payment, and health operations or any other disclosures as allowed by law in connection with any accident, medical incident, or claim made.
Photographs and/or video sound recordings and evaluation comments of the undersigned may be gathered during the trip. The undersigned authorizes the use of such material by Mazatlán Missions – Impact Adventure and their subsidiaries, affiliates, licenses, successors and assignees, for their purposes. There is no reservation or agreement not clearly expressed herein.
The undersigned has read this Risk Acknowledgment and Release Statement and understands all of its terms. The undersigned executes it voluntarily, and with full knowledge and intention to be legally bound. This Risk Acknowledgment and Release Statement is made in and shall be governed by and construed according to the laws of the State of Colorado, United States of America.
Your electronic signature, or a minor’s parent’s signature, at the end of acknowledgment of Terms and Conditions, Risk & Release, verifies that you have read, understood, and agreed to this Risk Acknowledgement and Release Statement.
I agree to the Risk Acknowledgement & Release Statement.
Your Signature
*
(or Parent’s Signature if under 18)
Medical Release Form
Are you part of a group?
Yes
No
Group Name
Your Name
Medical Release Consent
*
I, (Name), hereby give permission for any and all medical attention to be administered to me in the event of an accident, injury, sickness, etc. I (or guardian) also assume financial responsibility for any treatment
I agree.
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City
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American Samoa
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Samoa
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Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
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Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
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South Georgia and the South Sandwich Islands
South Sudan
Spain
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Sudan
Suriname
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Sweden
Switzerland
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Taiwan
Tajikistan
Tanzania, the United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkmenistan
Turks and Caicos Islands
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US Minor Outlying Islands
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United Kingdom
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Uzbekistan
Vanuatu
Venezuela
Viet Nam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Ã…land Islands
Country
Phone
Insurance Company
Policy Number
Physician
Physician Phone Number
Physician's Address
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo
Congo, Democratic Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czechia
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic People's Republic of
Korea, Republic of
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Macedonia
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Réunion
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syria Arab Republic
Taiwan
Tajikistan
Tanzania, the United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkmenistan
Turks and Caicos Islands
Tuvalu
Türkiye
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Viet Nam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Ã…land Islands
Country
Known Allergies
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Pertinent Medical Information
In case of emergency, please contact the following persons:
Name, Relationship, Phone Number
Your Signature
Date
MM slash DD slash YYYY
For Minors (under 18) only:
Chaperone/Leader Name
Child's Name
Minor Medical Release Consent
*
(Chaperone/Leader Name) has my permission to obtain emergency medical treatment for my child, (Child’s Name)
when I cannot be reached or if a delay in reaching a guardian may be dangerous for him/her.
I agree.
Parent Signature
Date
MM slash DD slash YYYY
Make A Payment
Are you part of a group?
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Group Name
Your Name
First
Last
Email
Vehicle Registration Information
Rental Company Name
# of Vehicles
Type of Vehicle
Destination Flight Information
Airline
Flight Number
Arrival Time
Home Flight Information
Airline
Flight Number
Departure Time
Upload an Image
Passport and/or Drivers License.
Accepted file types: jpg, gif, png, pdf, Max. file size: 32 MB.