<form-template> <fields> <field type="header" subtype="h2" label="COVID-19 WAIVER FORM"/> <field type="paragraph" subtype="p" label="The 2019 Novel Coronavirus* (COVID-19, "Coronavirus") is a known and rapidly evolving pandemic that is affecting travel worldwide with continued spread and impacts expected. Client is fully aware of the global Coronavirus COVID-19 virus outbreak, the current travel restrictions, and inherent risks involved if choosing to travel."/> <field type="paragraph" subtype="p" label="Client understand that it is his/her responsibility to check the latest travel information regarding this virus outbreak with the CDC. https://wwwnc.cdc.gov/travel/notices"/> <field type="paragraph" subtype="p" label="Client understand that it is his/her responsibility to have travel insurance to ensure they have coverage for all medical needs ad trip cancellation but understands that concerns or fear of travel is not a covered reason for cancellation relating to the Coronavirus/COVID-19 and will be denied. Client understand that he/she is bound by the terms of the insurance policy as it relates to Coronavirus/COVID-19. Client holds sublimeXcursions LLC harmless for his/her election to not purchase travel insurance or any denial of claim by travel insurer, including but not limited to monetary losses, as it relates to COVID-19 or any other claim under the policy."/> <field type="paragraph" subtype="p" label="Travel insurance generally only covers unforeseen events. Most insurers classified COVID-19 as a "known event" late January 2020. Most policies have a specific clause stating they do not cover epidemics and pandemics, especially when travel warnings are in place."/> <field type="paragraph" subtype="p" label="Client is aware that additional screening procedures and restrictions may take place at airports and in public areas. Client is aware that these restrictions may include mandatory face coverings and/or temperature checks in airports, hotels, cruise ships, trains, or other means of transport."/> <field type="paragraph" subtype="p" label="Client is aware that Immigration restrictions may be put in place before or during your travels that may impede your ability to enter or exit your destination as planned. Self-quarantine of a minimum of 14 days may be required by some destinations upon arrival."/> <field type="paragraph" subtype="p" label="Client is aware that it is his/her personal decision to travel and is doing so with full knowledge of current travel recommendations and travel restrictions with regards to the Coronavirus COVID-19 and takes full responsibility for his/her actions with regards to this."/> <field type="paragraph" subtype="p" label="By providing my information below I acknowledge that I have read the above COVID-19 Waiver for Travel Disruptions and fully understand its contents. I am 18 years of age or older and voluntarily agree to the terms and conditions stated above."/> <field type="header" subtype="h1" label=" "/> <field type="text" required="true" label="First name" name="first-name" subtype="text" className="form-control"/> <field type="text" label="Middle name" name="middle-name" subtype="text" className="form-control"/> <field type="text" required="true" label="Last name" name="last-name" subtype="text" className="form-control"/> <field type="text" required="true" label="Address Line 1" name="address-line-1" subtype="text" className="form-control"/> <field type="text" label="Address Line 2" name="address-line-2" subtype="text" className="form-control"/> <field type="text" required="true" label="City" name="address-city" subtype="text" className="form-control"/> <field type="text" required="true" label="State" name="address-state" subtype="text" className="form-control"/> <field type="text" required="true" label="Zip" name="address-zip" subtype="text" className="form-control"/> <field type="text" required="true" label="Email" name="email" subtype="text" className="form-control"/> <field type="text" required="true" label="Phone number" name="phone-number" subtype="text" className="form-control"/> <field type="date" required="true" label="Departure Date" name="date-1588096905772" className="form-control"/> <field type="date" required="true" label="Today's Date" name="todays-date" className="form-control"/> </fields> </form-template>
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