Customer name:

___________________________________________________________________________

Trip name:
_____________________________________________________________________________

Insurance company:
_____________________________________________________________________________

Policy number:_________________________________________________________________

Emergency telephone number:____________________________________________________

Medical condition:
_____________________________________________________________________________

I am aware that taking part in adventure activities in remote locations brings with it certain
inherent risks, including personal injury, that Outdoor Perú Explorer cannot eliminate.

These risks do not detract from the adventure experience or the reason for taking part. I am
willing to accept the inherent risks and personal injuries that may occur on a trip of this nature.
At the same time, I have taken out personal travel insurance that will cover personal injury
(including search and rescue) in the event of an accident while participating in these adventure
activities. I agree that I am empowered to request any information that may help me
understand the risks inherent in the activity(ies).

I understand that individual adventure activities may require me to engage in continuous

moderate exercise for several hours. I believe that I am capable of this and I agree to inform
the Outdoor Perú Explorer staff of any medical conditions that I think they should be aware of.
I also agree to inform the staff of Outdoor Perú Explorer about any factor that may affect my
safety or that of any other person. I understand that this document is not a disclaimer and in
no way affects the duty of care that Outdoor Perú Explorer must demonstrate.

In the unlikely event of personal injury, I understand that Outdoor Perú Explorer can only be
held liable by a reasonable person possessing the level of experience that Outdoor Perú
Explorer staff have, as established by Peruvian law.
RESPONSIBILITY FOR PASSENGER SAFETY
The client traveling with Outdoor Perú Explorer is expected to comply with certain basic safety
rules, which include:

• Inform the guide of any medical condition or any factor that may affect her safety or that of
another person.

• Respect the guide's decisions.

• Be responsible and take care of the individual equipment assigned to you.

• Stay covered to avoid sun exposure and insect bites.

• Drink plenty of water to avoid sunstroke and dehydration.

• Understand that you are entering National Parks and that you must comply with certain rules
related to litter, restricted areas, waste and wildlife.

• Be honest with yourself about how comfortable you feel and if your limits are being pushed.

• Advising your guide if an untreated medical emergency arises could jeopardize the safety of
the entire group.

By signing this, I/we understand that the activities we are undertaking carry inherent risks
including risk of accident and/or injury. We also understand that we are empowered to ask
questions about the nature of these risks.

Signed: ________________________________________________________