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		<field type="header" subtype="h2" label="Traveler Information"/>&#13;
		<field type="select" required="true" label="Title" name="title" className="form-control">&#13;
			<option label="Mr." value="mr">Mr.</option>&#13;
			<option label="Mrs" value="mrs">Mrs</option>&#13;
			<option label="Ms" value="ms">Ms</option>&#13;
		</field>&#13;
		<field type="text" required="true" label="First name" name="first-name" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Middle name" name="middle-name" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Last name" name="last-name" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Preferred name" name="preferred-name" subtype="text" className="form-control"/>&#13;
		<field type="date" required="true" label="Birthday" name="birthday" className="form-control"/>&#13;
		<field type="text" required="true" label="Email" name="email" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Phone number" name="phone-number" subtype="text" className="form-control"/>&#13;
		<field type="header" subtype="h2" label="Address"/>&#13;
		<field type="text" required="true" label="Line 1" name="address-line-1" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Line 2" name="address-line-2" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="City" name="address-city" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="State" name="address-state" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Zip" name="address-zip" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Country" name="address-country" subtype="text" className="form-control"/>&#13;
		<field type="header" subtype="h2" label="Passport Info"/>&#13;
		<field type="text" label="Full name as it appears on passport" name="passport-name" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Passport number" name="passport-number" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Country of issue" name="passport-country-of-issue" subtype="text" className="form-control"/>&#13;
		<field type="date" label="Date of issue" name="passport-date-of-issue" className="form-control"/>&#13;
		<field type="date" label="Date of expiration" name="passport-date-of-expiration" className="form-control"/>&#13;
		<field type="radio-group" label="Gender" name="gender">&#13;
			<option label="F" value="female">F</option>&#13;
			<option label="M" value="male">M</option>&#13;
			<option label="X" value="other">X</option>&#13;
		</field>&#13;
		<field type="text" label="Place of birth" name="place-of-birth" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Nationality" name="nationality" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Citizenship" name="citizenship" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Favorite Color" name="favorite-color" subtype="text" className="form-control"/>&#13;
		<field type="radio-group" required="true" label="Are you traveling with a companion?" name="are-you-rooming-with-someone">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
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		<field type="header" subtype="h2" label="Travel Companion Information"/>&#13;
		<field type="select" label="Title" name="select-1653267792797" className="form-control">&#13;
			<option label="Mr." value="mr">Mr.</option>&#13;
			<option label="Mrs" value="mrs">Mrs</option>&#13;
			<option label="Ms" value="ms">Ms</option>&#13;
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		<field type="text" label="Companion First Name" description="N/A if not applicable" name="companion-first-name" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Companion Last Name" description="N/A if not applicable" name="companion-last-name" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Companion Email Address" description="N/A if not applicable" name="companion-email-address" subtype="text" className="form-control"/>&#13;
		<field type="date" label="Companion Birthday" description="any date if not applicable" name="companion-birthday" className="form-control"/>&#13;
		<field type="checkbox-group" required="true" label="Bedding Preference" name="bedding-preference">&#13;
			<option label="1 Bed" value="1-bed">1 Bed</option>&#13;
			<option label="2 Beds" value="2-beds">2 Beds</option>&#13;
		</field>&#13;
		<field type="header" subtype="h1" label="Additional Information&amp;nbsp;"/>&#13;
		<field type="text" required="true" label="Do you have any medical conditions we need to be aware of?" name="do-you-have-any-medical-conditions-we-need-to-be-aware-of" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Do you have any dietary restrictions or food allergies?" name="do-you-have-any-dietary-restrictions-or-food-allergies" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Anything else you think we should know? (Special requests, traveling with a group, comments, notes, etc.)" name="anything-else-you-think-we-should-know-special-requests-traveling-with-a-group-comments-notes-etc" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Where you referred by anyone? If so, please list their first and last name." name="where-you-referred-by-anyone-if-so-please-list-their-first-and-last-name" subtype="text" className="form-control"/>&#13;
		<field type="header" subtype="h1" label="Emergency Contact Information&amp;nbsp;"/>&#13;
		<field type="text" required="true" label="Contact Full Name" name="contact-full-name" subtype="text" className="form-control"/>&#13;
		<field type="text" subtype="tel" required="true" label="Contact Phone Number" name="contact-phone-number" className="form-control"/>&#13;
		<field type="text" subtype="email" required="true" label="Contact Email Address" name="contact-email-address" className="form-control"/>&#13;
		<field type="text" required="true" label="Relationship to You" name="relationship-to-you" subtype="text" className="form-control"/>&#13;
		<field type="header" subtype="h1" label="Travel Protection"/>&#13;
		<field type="checkbox-group" required="true" label="I have been advised of the option to purchase travel protection." name="i-have-been-advised-of-the-option-to-purchase-travel-protection">&#13;
			<option label="I agree and understand that my investment is at risk if travel protection is not purchased." value="i-agree-and-understand-that-my-investment-is-at-risk-if-travel-protection-is-not-purchased">I agree and understand that my investment is at risk if travel protection is not purchased.</option>&#13;
		</field>&#13;
		<field type="radio-group" required="true" label="Would you like to purchase travel protection at this time?" name="would-you-like-to-purchase-travel-protection-at-this-time">&#13;
			<option label="Yes, I would like for you to provide me with travel protection options." value="yes-i-would-like-for-you-to-provide-me-with-travel-protection-options">Yes, I would like for you to provide me with travel protection options.</option>&#13;
			<option label="No, I have already purchased travel protection." value="no-i-have-already-purchased-travel-protection">No, I have already purchased travel protection.</option>&#13;
			<option label="No, I am not interested at this time. I understand if I do not purchase travel protection my investment is at risk." value="no-i-am-not-interested-at-this-time-i-understand-if-i-do-not-purchase-travel-protection-my-investment-is-at-risk">No, I am not interested at this time. I understand if I do not purchase travel protection my investment is at risk.</option>&#13;
		</field>&#13;
		<field type="header" subtype="h1" label="Cancellation and Refund Policy"/>&#13;
		<field type="checkbox-group" required="true" label="Cancellation Policy Acknowledgement" name="cancellation-policy-acknowledgement">&#13;
			<option label="Yes, I have read, accept, and agree to abide by Boots Travel, LLC Refund and Cancellation Policy. I also understand that all payments are non-refundable and non-transferable." value="yes-i-have-read-accept-and-agree-to-abide-by-boots-travel-llc-refund-and-cancellation-policy-i-also-understand-that-all-payments-are-nonrefundable-and-nontransferable">Yes, I have read, accept, and agree to abide by Boots Travel, LLC Refund and Cancellation Policy. I also understand that all payments are non-refundable and non-transferable.</option>&#13;
		</field>&#13;
		<field type="checkbox-group" required="true" label="Refunds" name="refunds">&#13;
			<option label="Yes, I understand that all payment to Boots Travel, LLC is non-refundable and non-transferrable. This is because Boots Travel  has contractual agreements with our hotel, transportation, and other vendors that will not allow us to obtain any refunds." value="yes-i-understand-that-all-payment-to-boots-travel-llc-is-nonrefundable-and-nontransferrable-this-is-because-boots-travel-has-contractual-agreements-with-our-hotel-transportation-and-other-vendors-that-will-not-allow-us-to-obtain-any-refunds">Yes, I understand that all payment to Boots Travel, LLC is non-refundable and non-transferrable. This is because Boots Travel  has contractual agreements with our hotel, transportation, and other vendors that will not allow us to obtain any refunds.</option>&#13;
		</field>&#13;
		<field type="checkbox-group" required="true" label="Payment Disputes" name="payment-disputes">&#13;
			<option label="Yes, I agree to not file a payment dispute or chargeback through their bank/financial institution and to instead utilize the purchased travel insurance if they can no longer attend the planned trip. Traveler agrees to not file a chargeback in violation of  Boots, Travel LLC Refund Policy. If a chargeback is requested and/or processed, Traveler agrees to repay Boots Travel for the full amount and be responsible for any fees incurred in recouping payment, including attorney’s fees." value="yes-i-agree-to-not-file-a-payment-dispute-or-chargeback-through-their-bankfinancial-institution-and-to-instead-utilize-the-purchased-travel-insurance-if-they-can-no-longer-attend-the-planned-trip-traveler-agrees-to-not-file-a-chargeback-in-violation-of-boots-travel-llc-refund-policy-if-a-chargeback-is-requested-andor-processed-traveler-agrees-to-repay-boots-travel-for-the-full-amount-and-be-responsible-for-any-fees-incurred-in-recouping-payment-including-attorneys-fees">Yes, I agree to not file a payment dispute or chargeback through their bank/financial institution and to instead utilize the purchased travel insurance if they can no longer attend the planned trip. Traveler agrees to not file a chargeback in violation of  Boots, Travel LLC Refund Policy. If a chargeback is requested and/or processed, Traveler agrees to repay Boots Travel for the full amount and be responsible for any fees incurred in recouping payment, including attorney’s fees.</option>&#13;
		</field>&#13;
		<field type="header" subtype="h1" label="Release Liability"/>&#13;
		<field type="checkbox-group" required="true" label="Hazardous Materials Disclosure Acknowledgement" name="i-acknowledge-the-us-department-of-transportations-hazardous-materials-restrictions-and-agree-to-abide-by-these-regulations">&#13;
			<option label="I acknowledge the U.S. Department of Transportation's Hazardous Materials restrictions and agree to abide by these regulations." value="i-acknowledge-the-us-department-of-transportations-hazardous-materials-restrictions-and-agree-to-abide-by-these-regulations">I acknowledge the U.S. Department of Transportation's Hazardous Materials restrictions and agree to abide by these regulations.</option>&#13;
		</field>&#13;
		<field type="checkbox-group" required="true" label="Covid-19 Release of Liability" name="covid19-release-of-liability">&#13;
			<option label="Yes, I understand that Covid-19 emerged in the In Spring 2020, and is declared a worldwide pandemic. If contracted, this virus has the ability to cause the traveler extreme illness, including, but not limited to death. I understand that I am taking the risk of traveling with the knowledge that of the effects of contracting COVID-19 and the ever changing travel requirements that may occur because of the pandemic." value="yes-i-understand-that-covid19-emerged-in-the-in-spring-2020-and-is-declared-a-worldwide-pandemic-if-contracted-this-virus-has-the-ability-to-cause-the-traveler-extreme-illness-including-but-not-limited-to-death-i-understand-that-i-am-taking-the-risk-of-traveling-with-the-knowledge-that-of-the-effects-of-contracting-covid19-and-the-ever-changing-travel-requirements-that-may-occur-because-of-the-pandemic">Yes, I understand that Covid-19 emerged in the In Spring 2020, and is declared a worldwide pandemic. If contracted, this virus has the ability to cause the traveler extreme illness, including, but not limited to death. I understand that I am taking the risk of traveling with the knowledge that of the effects of contracting COVID-19 and the ever changing travel requirements that may occur because of the pandemic.</option>&#13;
		</field>&#13;
		<field type="checkbox-group" required="true" label="Covid-19 Test Mandate" name="covid19-test-mandate">&#13;
			<option label="I understand that I may be required to present a negative Covid-19 test prior to my arrival date." value="i-understand-that-i-may-be-required-to-present-a-negative-covid19-test-prior-to-my-arrival-date">I understand that I may be required to present a negative Covid-19 test prior to my arrival date.</option>&#13;
		</field>&#13;
		<field type="checkbox-group" required="true" label="Release of Liability" name="release-of-liability">&#13;
			<option label="Yes, I understand that Boots Travel, LLC its shareholders, directors, officers, employees, and affiliates, does not own or operate any entity which is to or does provide goods or services for your trip including, for example, ownership or control over hotels or other lodging facilities, airline, vessel, bus, van or other transportation companies, local ground operators, providers or organizers of optional excursions or equipment used thereon, food service or entertainment providers, etc. All such persons and entities are independent contractors. As a result, Boots Travel is not liable for any negligent or willful act or failure to act of any such person or entity, or of any other third party. Without limitation, Boots Travel is not responsible for any injury, loss, or damage to person or property, death, delay or inconvenience in connection with the provision of any goods or services occasioned by or resulting from, but not limited to, acts of God, acts of government, force majeure, acts of war or civil unrest, insurrection or revolt, strikes or other labor activities, criminal or terrorist activities of any kind, or the threat thereof, overbooking or downgrading of accommodations, structural or other defective conditions in hotels or other lodging facilities, mechanical or other failure of airplanes or other means of transportation or for any failure of any transportation mechanism to arrive or depart timely or safely, dangers associated with or bites from animals, pests or insects, marine life or vegetation of any sort, dangers incident to recreational activities such as swimming, kayaking, sailing, canoeing, rafting, hiking, walking, bicycling, etc., sanitation problems, food poisoning, lack of access to or quality of medical care, difficulty in evacuation in case of a medical or other emergency, illness, epidemics or the threat thereof or for any other cause beyond the direct control of Boots Travel. In addition, I (The Traveler) release Boots Travels from its own negligence and assume all risk thereof." value="yes-i-understand-that-boots-travel-llc-its-shareholders-directors-officers-employees-and-affiliates-does-not-own-or-operate-any-entity-which-is-to-or-does-provide-goods-or-services-for-your-trip-including-for-example-ownership-or-control-over-hotels-or-other-lodging-facilities-airline-vessel-bus-van-or-other-transportation-companies-local-ground-operators-providers-or-organizers-of-optional-excursions-or-equipment-used-thereon-food-service-or-entertainment-providers-etc-all-such-persons-and-entities-are-independent-contractors-as-a-result-boots-travel-is-not-liable-for-any-negligent-or-willful-act-or-failure-to-act-of-any-such-person-or-entity-or-of-any-other-third-party-without-limitation-boots-travel-is-not-responsible-for-any-injury-loss-or-damage-to-person-or-property-death-delay-or-inconvenience-in-connection-with-the-provision-of-any-goods-or-services-occasioned-by-or-resulting-from-but-not-limited-to-acts-of-god-acts-of-government-force-majeure-acts-of-war-or-civil-unrest-insurrection-or-revolt-strikes-or-other-labor-activities-criminal-or-terrorist-activities-of-any-kind-or-the-threat-thereof-overbooking-or-downgrading-of-accommodations-structural-or-other-defective-conditions-in-hotels-or-other-lodging-facilities-mechanical-or-other-failure-of-airplanes-or-other-means-of-transportation-or-for-any-failure-of-any-transportation-mechanism-to-arrive-or-depart-timely-or-safely-dangers-associated-with-or-bites-from-animals-pests-or-insects-marine-life-or-vegetation-of-any-sort-dangers-incident-to-recreational-activities-such-as-swimming-kayaking-sailing-canoeing-rafting-hiking-walking-bicycling-etc-sanitation-problems-food-poisoning-lack-of-access-to-or-quality-of-medical-care-difficulty-in-evacuation-in-case-of-a-medical-or-other-emergency-illness-epidemics-or-the-threat-thereof-or-for-any-other-cause-beyond-the-direct-control-of-boots-travel-in-addition-i-the-traveler-release-boots-travels-from-its-own-negligence-and-assume-all-risk-thereof">Yes, I understand that Boots Travel, LLC its shareholders, directors, officers, employees, and affiliates, does not own or operate any entity which is to or does provide goods or services for your trip including, for example, ownership or control over hotels or other lodging facilities, airline, vessel, bus, van or other transportation companies, local ground operators, providers or organizers of optional excursions or equipment used thereon, food service or entertainment providers, etc. All such persons and entities are independent contractors. As a result, Boots Travel is not liable for any negligent or willful act or failure to act of any such person or entity, or of any other third party. Without limitation, Boots Travel is not responsible for any injury, loss, or damage to person or property, death, delay or inconvenience in connection with the provision of any goods or services occasioned by or resulting from, but not limited to, acts of God, acts of government, force majeure, acts of war or civil unrest, insurrection or revolt, strikes or other labor activities, criminal or terrorist activities of any kind, or the threat thereof, overbooking or downgrading of accommodations, structural or other defective conditions in hotels or other lodging facilities, mechanical or other failure of airplanes or other means of transportation or for any failure of any transportation mechanism to arrive or depart timely or safely, dangers associated with or bites from animals, pests or insects, marine life or vegetation of any sort, dangers incident to recreational activities such as swimming, kayaking, sailing, canoeing, rafting, hiking, walking, bicycling, etc., sanitation problems, food poisoning, lack of access to or quality of medical care, difficulty in evacuation in case of a medical or other emergency, illness, epidemics or the threat thereof or for any other cause beyond the direct control of Boots Travel. In addition, I (The Traveler) release Boots Travels from its own negligence and assume all risk thereof.</option>&#13;
		</field>&#13;
		<field type="header" subtype="h1" label="Terms and Conditions"/>&#13;
		<field type="checkbox-group" required="true" label="Terms and Conditions" name="terms-and-conditions">&#13;
			<option label="I agree and acknowledge that all the information above is correct. I also acknowledge and accept the terms and conditions of Boots Travel, LLC." value="i-agree-and-acknowledge-that-all-the-information-above-is-correct-i-also-acknowledge-and-accept-the-terms-and-conditions-of-boots-travel-llc">I agree and acknowledge that all the information above is correct. I also acknowledge and accept the terms and conditions of Boots Travel, LLC.</option>&#13;
		</field>&#13;
		<field type="checkbox-group" required="true" label="Reservation Submission" name="reservation-submission">&#13;
			<option label="Submitting information via this reservation form DOES NOT automatically confirm your reservation or charge your credit card. After you submit this form, Boots Travel, LLC  will check the most current rates for your chosen room category and contact you with any rate changes. At that time, you will confirm you want to move forward with the reservation. After the reservation has been made and the payment processed, we will send you an email confirmation of your reservation and payment received." value="submitting-information-via-this-reservation-form-does-not-automatically-confirm-your-reservation-or-charge-your-credit-card-after-you-submit-this-form-boots-travel-llc-will-check-the-most-current-rates-for-your-chosen-room-category-and-contact-you-with-any-rate-changes-at-that-time-you-will-confirm-you-want-to-move-forward-with-the-reservation-after-the-reservation-has-been-made-and-the-payment-processed-we-will-send-you-an-email-confirmation-of-your-reservation-and-payment-received">Submitting information via this reservation form DOES NOT automatically confirm your reservation or charge your credit card. After you submit this form, Boots Travel, LLC  will check the most current rates for your chosen room category and contact you with any rate changes. At that time, you will confirm you want to move forward with the reservation. After the reservation has been made and the payment processed, we will send you an email confirmation of your reservation and payment received.</option>&#13;
		</field>&#13;
		<field type="checkbox-group" required="true" label="Invoice Accuracy" name="invoice-accuracy">&#13;
			<option label="It is your responsibility to review the invoice upon receipt to ensure 100% accuracy. Please check thoroughly for any discrepancies or errors. Boots Travel, LLC  is NOT responsible for errors, or any fees associated with necessary changes after 24 hours of receipt. " value="it-is-your-responsibility-to-review-the-invoice-upon-receipt-to-ensure-100-accuracy-please-check-thoroughly-for-any-discrepancies-or-errors-boots-travel-llc-is-not-responsible-for-errors-or-any-fees-associated-with-necessary-changes-after-24-hours-of-receipt-">It is your responsibility to review the invoice upon receipt to ensure 100% accuracy. Please check thoroughly for any discrepancies or errors. Boots Travel, LLC  is NOT responsible for errors, or any fees associated with necessary changes after 24 hours of receipt. </option>&#13;
		</field>&#13;
		<field type="radio-group" required="true" label="How did you hear about Boot Travel?" name="how-did-you-hear-about-this-trip" other="true">&#13;
			<option label="Facebook" value="facebook">Facebook</option>&#13;
			<option label="Instagram" value="instagram">Instagram</option>&#13;
			<option label="Twitter" value="twitter">Twitter</option>&#13;
			<option label="Website" value="website">Website</option>&#13;
		</field>&#13;
		<field type="text" label="If other, please specify" name="if-other-please-specify" subtype="text" className="form-control"/>&#13;
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By signing below, I authorize Boot Travel to charge the credit card provided herein.

BOOTS TRAVEL TERMS AND CONDITIONS
Please Note: By registering and paying for this trip you are agreeing to Boots Travel Terms and Conditions.

Terms & Conditions: Submitting a deposit and payments for this package signifies your acceptance of Boots Travels LLC's Terms & Conditions, Disclaimer Policy, and Privacy Policy.

Cancellation and Refund Policy

Cancellation Policy: If you cancel your reservation, all payments submitted to Boots Travels LLC will be non-refundable and non-transferable without travel insurance. You are strongly encouraged to protect your travel investment by purchasing travel insurance.

Final Payment: Final payment must be received on or before the final payment due date. Failure to submit the final payment as required will result in an automatic cancellation of the entire reservation. Boots Travels LLC will not be held responsible for any loss of funds due to cancellation.

Refunds: All payment to Boots Travels LLC is non-refundable and non-transferable. This is because Boots Travels LLC has contractual agreements with our hotel, transportation, and other vendors that will not allow us to obtain any refunds.

Reservations:
Guests must make reservations in the full name listed on their passport or ID that they will use for travel. Please confirm your passport will not expire within 6 months pre/post of your travel date. If you need to make any changes to a name after travel documents have been issued, clients will be responsible for all name change fees, if applicable.

Payments:
Deposit: A deposit is due at the time of reservation. All deposits are non-refundable and non-transferable. All reservations (except where specified) will require a deposit, and the amount due and the monthly payment plan will be clearly noted.

Full Payment: All reservations can be paid in full at the time of booking as long as the package still has available space

Reservation Name Changes:
Name changes due to incorrect information provided from the traveler will incur a $250 per person charge plus any additional supplier fees. Please note that name changes to airline reservations are subject to full cancellation and rebooking. Replacing a traveling passenger with another traveling passenger constitutes a cancellation, subject to cancellation penalties, and is not covered by this Reservation Name Changes policy. Changes or additions after departure are subject to local rates at the time of amendment and must be paid directly by the passenger to the service provider. There are no refunds for unused services.

Click to sign

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		<field type="header" subtype="h2" label="Traveler Information"/>&#13;
		<field type="select" required="true" label="Title" name="title" className="form-control">&#13;
			<option label="Mr." value="mr">Mr.</option>&#13;
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		<field type="text" required="true" label="First name" name="first-name" subtype="text" className="form-control"/>&#13;
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		<field type="text" required="true" label="City" name="address-city" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="State" name="address-state" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Zip" name="address-zip" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Country" name="address-country" subtype="text" className="form-control"/>&#13;
		<field type="header" subtype="h2" label="Passport Info"/>&#13;
		<field type="text" label="Full name as it appears on passport" name="passport-name" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Passport number" name="passport-number" subtype="text" className="form-control"/>&#13;
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			<option label="F" value="female">F</option>&#13;
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		<field type="text" label="Place of birth" name="place-of-birth" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Nationality" name="nationality" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Citizenship" name="citizenship" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Favorite Color" name="favorite-color" subtype="text" className="form-control"/>&#13;
		<field type="radio-group" required="true" label="Are you traveling with a companion?" name="are-you-rooming-with-someone">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
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			<option label="Mr." value="mr">Mr.</option>&#13;
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		<field type="text" label="Companion First Name" description="N/A if not applicable" name="companion-first-name" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Companion Last Name" description="N/A if not applicable" name="companion-last-name" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Companion Email Address" description="N/A if not applicable" name="companion-email-address" subtype="text" className="form-control"/>&#13;
		<field type="date" label="Companion Birthday" description="any date if not applicable" name="companion-birthday" className="form-control"/>&#13;
		<field type="checkbox-group" required="true" label="Bedding Preference" name="bedding-preference">&#13;
			<option label="1 Bed" value="1-bed">1 Bed</option>&#13;
			<option label="2 Beds" value="2-beds">2 Beds</option>&#13;
		</field>&#13;
		<field type="header" subtype="h1" label="Additional Information&amp;nbsp;"/>&#13;
		<field type="text" required="true" label="Do you have any medical conditions we need to be aware of?" name="do-you-have-any-medical-conditions-we-need-to-be-aware-of" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Do you have any dietary restrictions or food allergies?" name="do-you-have-any-dietary-restrictions-or-food-allergies" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Anything else you think we should know? (Special requests, traveling with a group, comments, notes, etc.)" name="anything-else-you-think-we-should-know-special-requests-traveling-with-a-group-comments-notes-etc" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Where you referred by anyone? If so, please list their first and last name." name="where-you-referred-by-anyone-if-so-please-list-their-first-and-last-name" subtype="text" className="form-control"/>&#13;
		<field type="header" subtype="h1" label="Emergency Contact Information&amp;nbsp;"/>&#13;
		<field type="text" required="true" label="Contact Full Name" name="contact-full-name" subtype="text" className="form-control"/>&#13;
		<field type="text" subtype="tel" required="true" label="Contact Phone Number" name="contact-phone-number" className="form-control"/>&#13;
		<field type="text" subtype="email" required="true" label="Contact Email Address" name="contact-email-address" className="form-control"/>&#13;
		<field type="text" required="true" label="Relationship to You" name="relationship-to-you" subtype="text" className="form-control"/>&#13;
		<field type="header" subtype="h1" label="Travel Protection"/>&#13;
		<field type="checkbox-group" required="true" label="I have been advised of the option to purchase travel protection." name="i-have-been-advised-of-the-option-to-purchase-travel-protection">&#13;
			<option label="I agree and understand that my investment is at risk if travel protection is not purchased." value="i-agree-and-understand-that-my-investment-is-at-risk-if-travel-protection-is-not-purchased">I agree and understand that my investment is at risk if travel protection is not purchased.</option>&#13;
		</field>&#13;
		<field type="radio-group" required="true" label="Would you like to purchase travel protection at this time?" name="would-you-like-to-purchase-travel-protection-at-this-time">&#13;
			<option label="Yes, I would like for you to provide me with travel protection options." value="yes-i-would-like-for-you-to-provide-me-with-travel-protection-options">Yes, I would like for you to provide me with travel protection options.</option>&#13;
			<option label="No, I have already purchased travel protection." value="no-i-have-already-purchased-travel-protection">No, I have already purchased travel protection.</option>&#13;
			<option label="No, I am not interested at this time. I understand if I do not purchase travel protection my investment is at risk." value="no-i-am-not-interested-at-this-time-i-understand-if-i-do-not-purchase-travel-protection-my-investment-is-at-risk">No, I am not interested at this time. I understand if I do not purchase travel protection my investment is at risk.</option>&#13;
		</field>&#13;
		<field type="header" subtype="h1" label="Cancellation and Refund Policy"/>&#13;
		<field type="checkbox-group" required="true" label="Cancellation Policy Acknowledgement" name="cancellation-policy-acknowledgement">&#13;
			<option label="Yes, I have read, accept, and agree to abide by Boots Travel, LLC Refund and Cancellation Policy. I also understand that all payments are non-refundable and non-transferable." value="yes-i-have-read-accept-and-agree-to-abide-by-boots-travel-llc-refund-and-cancellation-policy-i-also-understand-that-all-payments-are-nonrefundable-and-nontransferable">Yes, I have read, accept, and agree to abide by Boots Travel, LLC Refund and Cancellation Policy. I also understand that all payments are non-refundable and non-transferable.</option>&#13;
		</field>&#13;
		<field type="checkbox-group" required="true" label="Refunds" name="refunds">&#13;
			<option label="Yes, I understand that all payment to Boots Travel, LLC is non-refundable and non-transferrable. This is because Boots Travel  has contractual agreements with our hotel, transportation, and other vendors that will not allow us to obtain any refunds." value="yes-i-understand-that-all-payment-to-boots-travel-llc-is-nonrefundable-and-nontransferrable-this-is-because-boots-travel-has-contractual-agreements-with-our-hotel-transportation-and-other-vendors-that-will-not-allow-us-to-obtain-any-refunds">Yes, I understand that all payment to Boots Travel, LLC is non-refundable and non-transferrable. This is because Boots Travel  has contractual agreements with our hotel, transportation, and other vendors that will not allow us to obtain any refunds.</option>&#13;
		</field>&#13;
		<field type="checkbox-group" required="true" label="Payment Disputes" name="payment-disputes">&#13;
			<option label="Yes, I agree to not file a payment dispute or chargeback through their bank/financial institution and to instead utilize the purchased travel insurance if they can no longer attend the planned trip. Traveler agrees to not file a chargeback in violation of  Boots, Travel LLC Refund Policy. If a chargeback is requested and/or processed, Traveler agrees to repay Boots Travel for the full amount and be responsible for any fees incurred in recouping payment, including attorney’s fees." value="yes-i-agree-to-not-file-a-payment-dispute-or-chargeback-through-their-bankfinancial-institution-and-to-instead-utilize-the-purchased-travel-insurance-if-they-can-no-longer-attend-the-planned-trip-traveler-agrees-to-not-file-a-chargeback-in-violation-of-boots-travel-llc-refund-policy-if-a-chargeback-is-requested-andor-processed-traveler-agrees-to-repay-boots-travel-for-the-full-amount-and-be-responsible-for-any-fees-incurred-in-recouping-payment-including-attorneys-fees">Yes, I agree to not file a payment dispute or chargeback through their bank/financial institution and to instead utilize the purchased travel insurance if they can no longer attend the planned trip. Traveler agrees to not file a chargeback in violation of  Boots, Travel LLC Refund Policy. If a chargeback is requested and/or processed, Traveler agrees to repay Boots Travel for the full amount and be responsible for any fees incurred in recouping payment, including attorney’s fees.</option>&#13;
		</field>&#13;
		<field type="header" subtype="h1" label="Release Liability"/>&#13;
		<field type="checkbox-group" required="true" label="Hazardous Materials Disclosure Acknowledgement" name="i-acknowledge-the-us-department-of-transportations-hazardous-materials-restrictions-and-agree-to-abide-by-these-regulations">&#13;
			<option label="I acknowledge the U.S. Department of Transportation's Hazardous Materials restrictions and agree to abide by these regulations." value="i-acknowledge-the-us-department-of-transportations-hazardous-materials-restrictions-and-agree-to-abide-by-these-regulations">I acknowledge the U.S. Department of Transportation's Hazardous Materials restrictions and agree to abide by these regulations.</option>&#13;
		</field>&#13;
		<field type="checkbox-group" required="true" label="Covid-19 Release of Liability" name="covid19-release-of-liability">&#13;
			<option label="Yes, I understand that Covid-19 emerged in the In Spring 2020, and is declared a worldwide pandemic. If contracted, this virus has the ability to cause the traveler extreme illness, including, but not limited to death. I understand that I am taking the risk of traveling with the knowledge that of the effects of contracting COVID-19 and the ever changing travel requirements that may occur because of the pandemic." value="yes-i-understand-that-covid19-emerged-in-the-in-spring-2020-and-is-declared-a-worldwide-pandemic-if-contracted-this-virus-has-the-ability-to-cause-the-traveler-extreme-illness-including-but-not-limited-to-death-i-understand-that-i-am-taking-the-risk-of-traveling-with-the-knowledge-that-of-the-effects-of-contracting-covid19-and-the-ever-changing-travel-requirements-that-may-occur-because-of-the-pandemic">Yes, I understand that Covid-19 emerged in the In Spring 2020, and is declared a worldwide pandemic. If contracted, this virus has the ability to cause the traveler extreme illness, including, but not limited to death. I understand that I am taking the risk of traveling with the knowledge that of the effects of contracting COVID-19 and the ever changing travel requirements that may occur because of the pandemic.</option>&#13;
		</field>&#13;
		<field type="checkbox-group" required="true" label="Covid-19 Test Mandate" name="covid19-test-mandate">&#13;
			<option label="I understand that I may be required to present a negative Covid-19 test prior to my arrival date." value="i-understand-that-i-may-be-required-to-present-a-negative-covid19-test-prior-to-my-arrival-date">I understand that I may be required to present a negative Covid-19 test prior to my arrival date.</option>&#13;
		</field>&#13;
		<field type="checkbox-group" required="true" label="Release of Liability" name="release-of-liability">&#13;
			<option label="Yes, I understand that Boots Travel, LLC its shareholders, directors, officers, employees, and affiliates, does not own or operate any entity which is to or does provide goods or services for your trip including, for example, ownership or control over hotels or other lodging facilities, airline, vessel, bus, van or other transportation companies, local ground operators, providers or organizers of optional excursions or equipment used thereon, food service or entertainment providers, etc. All such persons and entities are independent contractors. As a result, Boots Travel is not liable for any negligent or willful act or failure to act of any such person or entity, or of any other third party. Without limitation, Boots Travel is not responsible for any injury, loss, or damage to person or property, death, delay or inconvenience in connection with the provision of any goods or services occasioned by or resulting from, but not limited to, acts of God, acts of government, force majeure, acts of war or civil unrest, insurrection or revolt, strikes or other labor activities, criminal or terrorist activities of any kind, or the threat thereof, overbooking or downgrading of accommodations, structural or other defective conditions in hotels or other lodging facilities, mechanical or other failure of airplanes or other means of transportation or for any failure of any transportation mechanism to arrive or depart timely or safely, dangers associated with or bites from animals, pests or insects, marine life or vegetation of any sort, dangers incident to recreational activities such as swimming, kayaking, sailing, canoeing, rafting, hiking, walking, bicycling, etc., sanitation problems, food poisoning, lack of access to or quality of medical care, difficulty in evacuation in case of a medical or other emergency, illness, epidemics or the threat thereof or for any other cause beyond the direct control of Boots Travel. In addition, I (The Traveler) release Boots Travels from its own negligence and assume all risk thereof." value="yes-i-understand-that-boots-travel-llc-its-shareholders-directors-officers-employees-and-affiliates-does-not-own-or-operate-any-entity-which-is-to-or-does-provide-goods-or-services-for-your-trip-including-for-example-ownership-or-control-over-hotels-or-other-lodging-facilities-airline-vessel-bus-van-or-other-transportation-companies-local-ground-operators-providers-or-organizers-of-optional-excursions-or-equipment-used-thereon-food-service-or-entertainment-providers-etc-all-such-persons-and-entities-are-independent-contractors-as-a-result-boots-travel-is-not-liable-for-any-negligent-or-willful-act-or-failure-to-act-of-any-such-person-or-entity-or-of-any-other-third-party-without-limitation-boots-travel-is-not-responsible-for-any-injury-loss-or-damage-to-person-or-property-death-delay-or-inconvenience-in-connection-with-the-provision-of-any-goods-or-services-occasioned-by-or-resulting-from-but-not-limited-to-acts-of-god-acts-of-government-force-majeure-acts-of-war-or-civil-unrest-insurrection-or-revolt-strikes-or-other-labor-activities-criminal-or-terrorist-activities-of-any-kind-or-the-threat-thereof-overbooking-or-downgrading-of-accommodations-structural-or-other-defective-conditions-in-hotels-or-other-lodging-facilities-mechanical-or-other-failure-of-airplanes-or-other-means-of-transportation-or-for-any-failure-of-any-transportation-mechanism-to-arrive-or-depart-timely-or-safely-dangers-associated-with-or-bites-from-animals-pests-or-insects-marine-life-or-vegetation-of-any-sort-dangers-incident-to-recreational-activities-such-as-swimming-kayaking-sailing-canoeing-rafting-hiking-walking-bicycling-etc-sanitation-problems-food-poisoning-lack-of-access-to-or-quality-of-medical-care-difficulty-in-evacuation-in-case-of-a-medical-or-other-emergency-illness-epidemics-or-the-threat-thereof-or-for-any-other-cause-beyond-the-direct-control-of-boots-travel-in-addition-i-the-traveler-release-boots-travels-from-its-own-negligence-and-assume-all-risk-thereof">Yes, I understand that Boots Travel, LLC its shareholders, directors, officers, employees, and affiliates, does not own or operate any entity which is to or does provide goods or services for your trip including, for example, ownership or control over hotels or other lodging facilities, airline, vessel, bus, van or other transportation companies, local ground operators, providers or organizers of optional excursions or equipment used thereon, food service or entertainment providers, etc. All such persons and entities are independent contractors. As a result, Boots Travel is not liable for any negligent or willful act or failure to act of any such person or entity, or of any other third party. Without limitation, Boots Travel is not responsible for any injury, loss, or damage to person or property, death, delay or inconvenience in connection with the provision of any goods or services occasioned by or resulting from, but not limited to, acts of God, acts of government, force majeure, acts of war or civil unrest, insurrection or revolt, strikes or other labor activities, criminal or terrorist activities of any kind, or the threat thereof, overbooking or downgrading of accommodations, structural or other defective conditions in hotels or other lodging facilities, mechanical or other failure of airplanes or other means of transportation or for any failure of any transportation mechanism to arrive or depart timely or safely, dangers associated with or bites from animals, pests or insects, marine life or vegetation of any sort, dangers incident to recreational activities such as swimming, kayaking, sailing, canoeing, rafting, hiking, walking, bicycling, etc., sanitation problems, food poisoning, lack of access to or quality of medical care, difficulty in evacuation in case of a medical or other emergency, illness, epidemics or the threat thereof or for any other cause beyond the direct control of Boots Travel. In addition, I (The Traveler) release Boots Travels from its own negligence and assume all risk thereof.</option>&#13;
		</field>&#13;
		<field type="header" subtype="h1" label="Terms and Conditions"/>&#13;
		<field type="checkbox-group" required="true" label="Terms and Conditions" name="terms-and-conditions">&#13;
			<option label="I agree and acknowledge that all the information above is correct. I also acknowledge and accept the terms and conditions of Boots Travel, LLC." value="i-agree-and-acknowledge-that-all-the-information-above-is-correct-i-also-acknowledge-and-accept-the-terms-and-conditions-of-boots-travel-llc">I agree and acknowledge that all the information above is correct. I also acknowledge and accept the terms and conditions of Boots Travel, LLC.</option>&#13;
		</field>&#13;
		<field type="checkbox-group" required="true" label="Reservation Submission" name="reservation-submission">&#13;
			<option label="Submitting information via this reservation form DOES NOT automatically confirm your reservation or charge your credit card. After you submit this form, Boots Travel, LLC  will check the most current rates for your chosen room category and contact you with any rate changes. At that time, you will confirm you want to move forward with the reservation. After the reservation has been made and the payment processed, we will send you an email confirmation of your reservation and payment received." value="submitting-information-via-this-reservation-form-does-not-automatically-confirm-your-reservation-or-charge-your-credit-card-after-you-submit-this-form-boots-travel-llc-will-check-the-most-current-rates-for-your-chosen-room-category-and-contact-you-with-any-rate-changes-at-that-time-you-will-confirm-you-want-to-move-forward-with-the-reservation-after-the-reservation-has-been-made-and-the-payment-processed-we-will-send-you-an-email-confirmation-of-your-reservation-and-payment-received">Submitting information via this reservation form DOES NOT automatically confirm your reservation or charge your credit card. After you submit this form, Boots Travel, LLC  will check the most current rates for your chosen room category and contact you with any rate changes. At that time, you will confirm you want to move forward with the reservation. After the reservation has been made and the payment processed, we will send you an email confirmation of your reservation and payment received.</option>&#13;
		</field>&#13;
		<field type="checkbox-group" required="true" label="Invoice Accuracy" name="invoice-accuracy">&#13;
			<option label="It is your responsibility to review the invoice upon receipt to ensure 100% accuracy. Please check thoroughly for any discrepancies or errors. Boots Travel, LLC  is NOT responsible for errors, or any fees associated with necessary changes after 24 hours of receipt. " value="it-is-your-responsibility-to-review-the-invoice-upon-receipt-to-ensure-100-accuracy-please-check-thoroughly-for-any-discrepancies-or-errors-boots-travel-llc-is-not-responsible-for-errors-or-any-fees-associated-with-necessary-changes-after-24-hours-of-receipt-">It is your responsibility to review the invoice upon receipt to ensure 100% accuracy. Please check thoroughly for any discrepancies or errors. Boots Travel, LLC  is NOT responsible for errors, or any fees associated with necessary changes after 24 hours of receipt. </option>&#13;
		</field>&#13;
		<field type="radio-group" required="true" label="How did you hear about Boot Travel?" name="how-did-you-hear-about-this-trip" other="true">&#13;
			<option label="Facebook" value="facebook">Facebook</option>&#13;
			<option label="Instagram" value="instagram">Instagram</option>&#13;
			<option label="Twitter" value="twitter">Twitter</option>&#13;
			<option label="Website" value="website">Website</option>&#13;
		</field>&#13;
		<field type="text" label="If other, please specify" name="if-other-please-specify" subtype="text" className="form-control"/>&#13;
	</fields>&#13;
</form-template>
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