Traveler Detail

Mailing Address

Participant Info

Travel Insurance Requirement*

Deposit Agreement*

Airfare Responsibility*

Vaccinations, Visa, and Passport*

Emergency Contact

IMPORTANT: Emergency contact must be someone that is NOT on the trip with you.

Release of Liability

Read the Release of Liability in its entirety, consent to submit.

DAZZLE AFRICA 

RELEASE OF LIABILITY, INDEMNITY, AND AGREEMENT 

This Release of Liability, Indemnity, and Agreement (the “Agreement”) is entered into by and between the parties described in the next two paragraphs: 

1. Each of the undersigned individual(s), their minor and adult children (and spouses thereof), and their spouse, heirs, next of kin, executors, administrators, assigns and personal representatives, and 

   
   

2. Dazzle Africa (a corporation organized under the laws of the State of Nevada), any and all of its parents, subsidiaries, and affiliates and their respective members, partners, officers, agents and employees (hereinafter collectively referred to as "Dazzle Africa"). 

The term “Participant” refers collectively and individually to the undersigned person(s) and, as applicable, to the other adult and minor travelers in the undersigned’s party. The term “Releasor” refers collectively to the Participant, their minor and adult children (and spouses thereof), and their spouse, heirs, next of kin, executors, administrators, assigns and personal representatives. 

Please read this Agreement, sign, initial, and fill out as required, and return it to Dazzle Africa.  You will not be confirmed on the Dazzle Africa safari trip described below (the “Safari”) until this Agreement has been completed in full and returned to Dazzle Africa. 

VOLUNTARY PARTICIPATION

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Releasor acknowledges that Participant has voluntarily applied to participate in a Dazzle Africa safari scheduled for the following dates:______________________ (the “Safari”). Releasor understands that safari travel involves activities which pose risks as set forth herein. Releasor is also aware that medical services or facilities may not be readily available or accessible during some or all of the time in which Participant is involved in the Safari. In order to partake of the enjoyment and excitement of this Safari, Releasor acknowledges that Releasor is willing to accept the risks and uncertainty involved as being an integral part of the Safari.

UNEXPECTED LOSSES

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Dazzle Africa is not responsible to any Participant for any damages, costs, expenses or losses of any kind arising out of or relating to any and all (a) airline schedule or airfare changes, cancellations or overbookings; (b) lodge or camp overbookings; (c) itinerary changes due to changing conditions (including without limitation seasonal rainfall and game migrations); or (d) failure of any lodge, camp or other third party to provide facilities and/or services as promised or that are satisfactory to any Participant.

RISKS

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Releasor fully understands the dangers, hazards and risks inherent and associated with the Safari and acknowledges and agrees that it is not possible for Dazzle Africa to make the Safari risk free or safe.  Releasor acknowledges and agrees that during the trip, the dangers, hazards and risks inherent to and associated with the Safari (hereinafter referred to as "Risks") may cause injury, death, damage, loss, accident, and/or delay.  The Risks include but are not limited to:

• The propensity of any wild animal to behave in ways that may result in injury, harm, or death to a Participant, other persons, animals, or property;

• The inherent danger that wild animals, reptiles, insects, and plants pose for persons and property;

• The potential for a Participant, other participants and other persons to behave in a negligent or unsafe manner that may contribute to injury to themselves or others;

• Travel in or on any vehicle, including without limitation any defect in any vehicle or other means of transportation used during the Safari and the potential for transportation accidents;

• The potential for theft or loss of any personal property;

• The potential for Participant's air carrier increasing flight prices or changing flight arrival or departure dates and times;

• The potential for losses or expenses due to sickness, weather, labor strikes, terrorists acts, hostilities, wars, natural disasters, or other such causes, resulting in the alteration, delay, extension or cancellation of the Safari;

• Death, injury or illness from accidents of any nature whatsoever, including but not limited to bodily injury of any nature, whether severe or not, temporary or permanent, that may occur as a result of participating in the Safari, including contact with the wild or domesticated animals, physical surroundings, environment, equipment or persons;

• Loss, injury, illness or death as a result of participation in the Safari, including but not limited to loss, death or injury as a result of any natural disaster or event, or extreme weather conditions; and

• Loss or injury, illness or death as a result of a crime or criminal act by third parties, terrorism, war, civil unrest, riot, detention by a foreign government, arrest or other act of government or authority.

Releasor acknowledges that the above list is not inclusive of all possible Risks associated with the Safari and that the above list in no way limits the extent or reach of this Agreement. Releasor voluntarily accepts and fully assumes any and all responsibility for all risks and possibilities of any and all delay, personal injury, death, damage to property or loss resulting from participation in the Safari.  Releasor acknowledges and accepts these risks and agrees to the terms and conditions of this Agreement.

RELEASE, DISCHARGE, AND INDEMNIFICATION

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As part of the consideration given to Dazzle Africa for Participant's participation in the Safari, Releasor, hereby, to the fullest extent permitted by law, releases and forever discharges Dazzle Africa from any and all liability for personal injury, death, damage to property, or loss resulting from any Participant's participation in the Safari due to any cause, including but not limited to negligence, breach of any duty imposed by law, breach of contract or mistake or error in judgment of Dazzle Africa.  Releasor hereby waives any and all claims of any kind and nature, whether conditional and unconditional, known and unknown, suspected and unsuspected, disclosed and undisclosed, that Releasor has or may have in the future against Dazzle Africa, except as may be solely caused by the willful or wanton misconduct of Dazzle Africa. Releasor shall indemnify, defend, and hold harmless Dazzle Africa from and against any and all losses, damages, liabilities, reasonable attorney fees, court costs, and expenses (collectively “Losses”), joint or several, resulting or arising from or relating to the subject matter of this Agreement, including without limitation any Participant’s participation (or inability to participate) in the Safari,  except to the extent such Losses are determined to have resulted solely from the willful or wanton misconduct of Dazzle Africa.

NO AGENCY 

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Releasor understands that Dazzle Africa in no way represents, or acts as agent for any third party, including without limitation, any transportation carrier, lodge, hotel, and other supplier of goods or services in connection with the Safari. 

UNACCEPTABLE CONDUCT

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The Participant agrees that, during the Safari, he/she/they will not engage in any unlawful conduct or any conduct that creates any unsafe condition or disruption for any other person or entity.  The Participant further agrees that, if a representative of Dazzle Africa determines in his or her discretion that the foregoing sentence has been violated, such representative may take any actions he or she deems necessary to ameliorate such conduct or disruption, including without limitation restricting such Participant from participating in any or all Safari activities, restricting such Participant from interfacing with or contacting any or all other persons in the Safari group or prohibiting such Participant from continuing to participate in the Safari.  Dazzle Africa shall have no liability to any Participant arising out of or relating to any such determinations and actions by Dazzle Africa or by such representative, made or taken in good faith.  Without limiting the generality of the foregoing, Participant acknowledges (i) that Participant likely will not be entitled to any refund of any amounts due to any restriction in or discontinuation of Participant’s participation in any or all Safari activities; and (ii) that Participant may incur additional costs (including without limitation for lodging, food and airfare) due to participation restrictions or discontinuation; and (iii) that Dazzle Africa has no liability to Participant for any costs to, or losses of, Participant due to any of the foregoing. 

INSURANCE

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Each Participant is solely responsible for ensuring that he/she carries the appropriate comprehensive travel and medical insurance to cover themselves, as well as any dependents and traveling companions, for the duration of the Safari. This insurance should include, at a minimum, coverage for the following: cancellation or curtailment of the Safari and any associated air travel, emergency evacuation expenses, medical expenses, repatriation expenses, damage, theft or loss of personal baggage, money and goods. We recommend you consult with your insurance provider to identify and evaluate any additional coverage available to you. Dazzle Africa is not responsible for any losses or costs incurred or suffered by any Participant, or Participant’s dependents or traveling companions, related to or arising out of, but not limited to, any of the above-mentioned events. The relevant service providers will charge Participants directly for emergency services, and Participants may not be able to access such services particularly if they do not carry the appropriate insurance coverage. 

MEDICAL AND HEALTH

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A measure of physical activity is involved in all African safaris and tours, including the Safari. Participants must be in generally good health to participate in the Safari. It is essential that Dazzle Africa be informed by Participants, or their parent(s)/guardian(s), well before departure of any dietary restrictions or any physical, medical or other health condition that could in any way impact participation in the Safari by any Participant or any other person. Dazzle Africa is not responsible for any limitations on your participation in the Safari arising from or related to your physical, medical or other health condition or dietary needs. All members of your group should take anti-malaria precautions (as well as all other medical precautions, including without limitation vaccinations, as are recommended by your health care providers), all of which are the sole responsibility of the Participant. Participant is solely responsible for the accuracy and completeness and of all medical information you supply us.  You should consult your medical and health care provider for up to date requirements and personal recommendations well before committing to participate in the Safari and well before departing on your Safari trip.

BY SIGNING THIS AGREEMENT, THE PARTICIPANT CERTIFIES THAT HE/SHE/THEY, AND ANY MINOR FOR WHOM HE/SHE/THEY IS (ARE) SIGNING THIS AGREEMENT, DOES/DO NOT HAVE ANY PHYSICAL, MEDICAL, HEALTH OR OTHER CONDITIONS, INCLUDING WITHOUT LIMITATION DIETARY RESTRICTIONS, THAT WOULD CREATE A RISK FOR HIM/HER OR OTHER SAFARI PARTICIPANTS.

ARBITRATION  

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Any controversy or claim arising out of or relating to this Agreement or the breach thereof shall be settled by arbitration, administered by the American Arbitration Association (“AAA”) under its Commercial Arbitration Rules and as governed by the Federal Arbitration Act contained in Title 9 of the United States Code.  Judgment on the award rendered by the arbitrator shall be binding and may be entered in any court having jurisdiction thereof.  Such arbitration shall be conducted, in English in or near Las Vegas, Nevada (or such other place as all parties may agree in writing), by one arbitrator selected in accordance with AAA rules.  Notwithstanding the foregoing, the parties acknowledge that certain violations of this Agreement could result in irreparable injury and damages to the other party that are difficult to measure. Therefore, any party hereto may seek temporary or preliminary injunctive relief (in any court of competent jurisdiction) pending the outcome of arbitration, the seeking or obtaining of which relief shall not be deemed to be a waiver of such party’s right to arbitrate and shall be in addition to all arbitration rights of such Party.  A demand for arbitration shall be made within a reasonable time after the claim, dispute, or controversy has arisen and in no event shall the demand for arbitration be made after the date when the institution of legal or equitable proceedings based on such claim, dispute, or other matter in controversy would be barred by the applicable statute of limitations.  The arbitrator may in the arbitrator’s discretion award costs and fees (including attorney’s fees) to the prevailing party.

PHOTO/VIDEO RELEASE 

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I hereby grant the Dazzle Africa permission to use my likeness in a photograph, video, or other digital media (“photo”) in any and all of its publications, including web-based publications, without payment or other consideration.

MODIFICATION AND WAIVER 

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Any modification of this Agreement will be effective only if it is in writing and signed by the party to be charged. The failure of any party hereto to insist on strict compliance with any of the terms, covenants, or conditions of this agreement by the other party shall not be deemed a waiver of that term, covenant, or condition, nor shall any waiver or relinquishment of any right or power at any one time or times be deemed a waiver or relinquishment of that right or power for all or any other times.

ASSIGNMENT OF AGREEMENT

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This Agreement may not be assigned by Participant without the prior written consent of Dazzle Africa.

VALIDITY OF TERMS 

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If any provision in this Agreement is held to be invalid, void or unenforceable under Nevada law, the remaining provisions shall nevertheless continue in full force without being impaired or invalidated in any way.

GOVERNING LAW, JURISDICTION, AND VENUE 

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The validity, interpretation and enforcement of this Agreement and of any of its terms or provisions, as well as the rights and duties of the parties under this Agreement, will be construed and determined pursuant to and in accordance with the law of Nevada. Releasor hereby irrevocably agrees that the courts of Nevada shall have the exclusive jurisdiction over any legal action or proceeding for injunctive relief (which is authorized in the above paragraph entitled “ARBITRATION”) regardless of who commences such actions or proceedings.  Releasor consents to the exclusive jurisdiction of such courts and waives any objection relating to the basis for personal or in rem jurisdiction or to venue which Releasor may now or hereafter have in any such legal action or proceedings. 

ENTIRE AGREEMENT 

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This Agreement supersedes any and all other agreements, either oral or in writing, between the parties hereto with respect to the subject of this Agreement. This Agreement contains all of the covenants and agreements between the parties with respect to the subject of this Agreement, and each party acknowledges that no representation, inducements, promises, or agreements have been made by or on behalf of any party, with respect to the subject of this Agreement, except the covenants and agreements embodied in this contract. No agreement, statement, or promise not contained in this Agreement is valid or binding between the parties with respect to the subject of this Agreement. 

REVIEW 

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Releasor acknowledges that he/she/they has/have been provided the opportunity to review this Agreement with independent counsel of their own choosing. This Agreement shall be construed fairly as to all parties and not in favor of or against any of the parties, regardless of which party actually prepared this Agreement.

Parent or Guardian of a minor(s)

Agree & Signature

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