Travel Insurance Waiver

I have been offered and advised of travel protection / trip insurance options and fees by my travel agent, MK Travel Services LLC and Michaela Krause

Name*
First Middle Last
Email*
Phone*
Trip Dates (mm/dd to mm/dd):*
Booking Confirmation Number*
Names of additional Travelers in your Party*
Do you have your own travel insurance?*
If yes, List Travel insurance and policy number:
If No, Reason for Decline of insurance:
Consent*
I decline the offer to purchase travel protection / trip insurance. I understand that I am solely responsible for any cancellation penalties and out-of-pocket expenses incurred. I will also make my own separate travel, medical and any other provisions in the event of an emergency while I am traveling. I also understand that I am not protected from loss in the event of any travel vendor, travel supplier or any travel-related operator default. This waiver confirms that I voluntarily decline travel insurance and travel protection insurance for the trip described above. I understand I am solely liable for all airline fees, supplier fees, and agency fees that may apply, and I hereby release MK Travel Serices LLC, Michaela Krause and its Agents from any and all liability related to the trip described above.
Consent*
Electronic Signature Consent
By checking here, you agree that your electronic signature is the legal equivalent of your handwritten signature. You consent to the use of electronic records and signatures for all documents related to this transaction. After consent you may, upon written request to us , obtain a paper copy af an electronic record
Signature
Date
Date Format: MM slash DD slash YYYY