Your Dental Vacation New smile For you and your family
Your  Dental  Vacation     New smile For you and your family 

 In consideration of my participation in the Activity described above, 
I agree as follows:  Assumption of Risk.


Activity: Dental Vacation in Tijuana, and Rosarito Mexico.  
(Valley of the Guadalupe. Ensenada, Rosarito Beach, Baja. Mexico. San Diego).

 

I hereby acknowledge that I have read the most recent U.S. Department of State Travel.  Warning for Mexico and the Consular Information Sheet on Mexico is available on ( travel.state.gov. ). I understand that it is my responsibility to be aware of and to read any revisions or updates to the Travel Warning that are issued between the date when I sign this Assumption of Risk and Release of Liability (“Release”) and the date of my return from the Activity. I understand the potential risks traveling to and in Mexico at this time as explained in the Travel Warning (and any subsequent revisions or updates) and that the security situation may change during my participation in the Activity.

 

I understand that I am solely responsible for my safety. I agree to exercise my best judgment and to follow any advice and safety precautions provided by staff involved with the Activity, but I recognize that Tours By André cannot guarantee my safety.  I understand that situations might arise during the Activity that are beyond the reasonable control of Tours By André or defaults of any other company or person engaged in providing services, provisions, accommodations, transportation or facilities in connection with this tour, nor are we liable for any damage, loss, or other acts of God connected with the activity, and that cell phone use may be limited or unavailable during the Activity.
 

I understand and acknowledge that my participation in the Activity is entirely voluntary, may involve serious risk, including but not limited to risk of property damage, bodily injury, permanent disability, paralysis and death.  These risks may result from the participation in the Activity, the acts of others, or the unavailability of emergency medical care or immediate staff response. I knowingly and freely assume all such risks, both known and unknown, and assume full responsibility for my participation in the Activity.

 

Release.

I (for myself, my parents, legal guardians, heirs, executors, administrators and assigns) hereby release, indemnify and hold harmless Tours By André, its trustees, employees, agents and volunteers (collectively “Releasees”) from and against any blame and liability whatsoever for any property damage, property loss, property theft, personal injury, death, claim, or any damage of any kind whatsoever, whether arising from the alleged negligence of the Releasees or otherwise, which may arise out of or relate in any way to my participation in the Activity, to the maximum extent permitted by applicable law. I agree to be solely responsible for any medical, health or personal injury costs relating to my participation in the Activity.

 

Conduct.

During the Activity, I will abide by the follow standards:  I will keep proper identification with me at all times during the Activity and while leaving and returning to the United States (e.g. passport, birth certificate, and government-issued photo identification such as a driver’s license). I will comply with all applicable laws. I will behave appropriately and will act with courtesy and respect towards others at all times, acknowledging that I am a guest in a foreign country.  If I have any questions regarding the Activity or what is expected of me, I will contact the coordinator of the Activity.

 

Pre-Medical Condition Disclosure.

I have the physical ability necessary to properly and safely participate in the Activity. I am in good physical and mental health and do not have any physical or mental conditions that could affect my ability to participate in the Activity.  I will also alert staff of the clinic, of any previous medical condition that may prevent me in participating in the activity.

 

No Assumption of Responsibility by Tours By André.
I understand that Tours By André, or defaults of any other company or person engaged in providing services, provisions, accommodations, transportation or facilities in connection with this tour does not assume responsibility for any loss, injury or damage to person or property in connection with my participation in the Activity, which results from causes beyond the control of and without fault of Tours By André.

 

Consent to Emergency Treatment.

I hereby consent to medical treatment in a medical emergency where I am unable at the time to consent to such treatment.


Insurance.
I agree to be solely responsible for any medical expenses or medical transport expense to treat any injury arising out of or related to my participation in the Activity.

 

I HAVE CAREFULLY READ THIS RELEASE, FULLY UNDERSTAND ITS TERMS,  
UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT,  AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT. NO  ORAL REPRESENTATIONS, STATEMENTS OR INDUCEMENTS APART FROM THIS RELEASE HAVE BEEN MADE.

Date(s) of travel

Location for hotel

Location for clinics

Description Treatment(s)

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Name      (Printed)                                                          
 

 

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Signature                                                                           Date

Assumption of Risk.

Disclaimer: Tours By André is a scheduling service, not a medical facility or healthcare provider. Tours By André  shall not be liable to you or anyone else for any decision made or action taken in reliance on this information.

This information does not constitute medical advice and does not create any physician-patient relationship. 

For a copy of the Assumption of Risk, please download the following document.  Just click on the PDF image.

Assumption of Risk..pdf
Adobe Acrobat document [1.6 MB]