Insurance Waiver

Insurance Waiver Form

Please fill out the form below if you are declining the trip insurance offered.

​I am refusing travel insurance for my trip. The risks for declining coverage have been explained to me by my Travel Advisor. I understand that declining travel insurance means I will lose all benefits of coverage and I fully accept that risk. I am aware that my own medical insurance may not cover me outside the United States. I UNDERSTAND THAT I WILL NOT BE COVERED FOR:

- Lost luggage - Missed connections or airline delays - Emergency air lift assistance - Emergency medical and/or dental assistance - Death of myself and/or my travel companion(s) - Any other covered circumstances as outlined in the offered travel insurance policy

I understand that I may lose up to 100% of the cost of my vacation package/travel arrangements if my trip is cancelled or delayed. I hereby release Darlene's Travel Services, LLC and my Travel Advisor from responsibility for any consequences, both known and unknown, resulting from my refusal of trip cancellation insurance. I understand that Darlene's Travel Services has advised me of the importance of such insurance, and I will not hold them responsible for any risks or lost funds. By signing this form, I confirm that I do not expect Darlene's Travel Services to assist me in any way if my trip is cancelled or delayed for any covered reason.
Please enter the booking number of the trip that you're declining travel insurance for
Please select your travel agent
Please enter the date that your vacation begins
By selecting the checkbox below and typing your name, you acknowledge that you have been offered Travel Insurance but decline to purchase it.