Reservation Form

STEP 1 Before filling the form you must read our Terms & Conditions, if you continue with the next steps we understand that you have read our Terms & Conditions and that you will sign the Waiver in agreement.

STEP 2 Fill the fields in the form containing your personal information (General data, Medical form and Emergency contact), the Services you are booking, the data needed to make the advance payment (advance payment amount and credit card data), and the Waiver and Release of Liability. Consider that only fields marked with * are mandatory but we would appreciate if you can fill them all of them for our information. If you are not sure how to fill-out the booking form, please get into the instructions page.

STEP 3 If you failed sending the form, you can download a PDF version of the Booking Form that you can print, fill-out and sign it before sending it to the fax number (591-2) 241-3273.

Reservation Details

Name *

Sex *

Masc

Fem

Date of Birth *

Year

Month

Day

Passport ID

Country

Phone

Occupation

Email *

Mailing Address

Are you vegetarian *

Yes

Dietary Restrictions *

Brief explanation of your previous experience *

Insurance data: company, coverage, policy information, etc

Medical Form

Are you physically active? *

Yes

Allergies *

Medical conditions *

Medication that you will be taken during the trip

Emergency contact

Full name

Relationship

Phone

Address

Email Address *

Services booked

Please refer to the trip's code or describe briefly the services booked *

Advance Payment Form

Card Number

Ammount US$

Expiration Date mm/yyyy

Bank´s Name

Security Code

Name on Card

Passport Number

Waiver and Release of Liability I,

,have been informed and am aware that adventure travel can be dangerous and includes certain risks and dangers that are an integral part of the trips and travel conditions and I accept them as a part of the reason for my participation on this trip.
Having my application being accepted by ANDEAN SUMMITS, I hereby agree as follows :

I release ANDEAN SUMMITS for all or any liability for any losses, damages or injuries or any claim or demand on account of any injury to my person or property.
I agree that if I am injured or ill, ANDEAN SUMMITS may, at my cost, arrange or supply medical treatment, evacuation or any other emergency services on my behalf as ANDEAN SUMMITS seems necessary or appropriate for my safety and well being.
I have read and agree to ANDEAN SUMMITS policies, stated under the terms and conditions.
I am aware I should purchase insurance coverage
I further agree that I will not have any illegal drugs on my person or in my possession when partaking in any part of any ANDEAN SUMMITS trips.

I have read and understand all the terms of this contract and agree to it of my own free will and without any reservation.

By entering my full name into the Signature Field below, I agree that is accepted as my signature for this transaction.

I have read and understand all the terms of this contract and agree to it of my own free will and without any reservation.

By entering my full name into the Signature Field below, I agree that is accepted as my signature for this transaction * Client signature

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