Application form for Kailash Mansarovar Yatra, July 2019

Personal Details:
Date of birth
GenderMaleFemale

Postal Address:

Passport Details:

Please make sure that you have a Passport with at at least 6 months validity. Fill in the following details exactly as they appear on your passport

Date of Issue
Date of Expiry

Person to contact in case of emergency:

Medical Information
Blood Group

Do you presently have or have ever had any of the medical conditions listed below? If so, please tick applicable & provide complete details:

Swelling of both feetBreathing DifficultyPalpitationsHigh BPLow BPDiabetesImpaired Glucose ToleranceHeart Problems since birthHeart AttackCardiac ArrestHeart Surgery / AngioplastyAsthmaBronchitisSinusitisPersistent CoughTuberculosisLung DisordersStrokeSeizuresNeurological ProblemsDepressionAnxietyVaricose veinBack painTransient loss of consciousness(on & off)Chest Pain on climbing stairs / walking on flat surfaceArthritis
Have you suffered any of the illness mentioned above? If yes, please give details:
Have you suffered any other illness NOT mentioned above? If yes, please give details:
Are you currently taking any medication for treatment of a medical condition? If yes, list name, dose and duration of the medication.
Do you smoke; consume Alcohol / Tobacco products / Addictive Drugs or Narcotics such as cocaine, heroin, etc on a regular basis?
YesNo
Do you have any food allergies or drug allergies? If yes, please specify here:

Declaration by the participant:

I
, hereby declare that I am willingly undertaking this pilgrimage to Kailash Mansarovar for my well-being at my own risk and will not lay blame under any circumstances for any loss, damage or possible injuries to person or property. I further indemnify ‘Earth Voice’ against all claims and suits and state that my legal heirs shall also not lay any claim against Earth Voice in this regard. Furthermore I state that I have undertaken a recent full medical examination and take full responsibility for my physical condition. I confirm that Earth Voice will bear no liability should any medical matter arise during trip and that I shall be financially responsible for any consequential medical expenses.

I confirm that all information provided is true and accurate and agree to it being shared with Earth Voice. I acknowledge the Earth Voice's terms and conditions.

I have understood the contents translated and read to me in a language that I fully understand.

Cancellation policy:
If I cancel the booking after making a reservation, I shall abide by the following cancellation policy: Once a booking is made, the deposit fee is non-refundable, irrespective of circumstances.

  • Cancellation made 45 days before the departure date – 25 % of total package cost.
  • Cancellation made 30 days before the departure date – 50 % total package cost.
  • No refunds for any cancellation made within 30 days from date of travel.
  • Services partially used / not used shall NOT be refundable.
  • I shall be eligible for full refund (excluding air-tickets cancellation charges if ticket would have been issued by then) if Earth Voice cancel the group departure for what so ever the reasons may be, such as failure to obtain VISA on time, or attain minimum group size due to the factors beyond their control.

In case of any eventuality i.e. casualty, itinerary deviation, flight cancellation / delays , baggage / personal loss etc., I shall not held Earth Voice, (India), its employees, principle suppliers, sub-agents or its associates responsible for the loss or damage to myself, my belongings or my onward journey arrangements.

Signature:
Date & Place:

By submitting this form, I agree to the Terms and Conditions mentioned below:
I acknowledge that the Earth Voice’s Kailash Yatra is challenging in various ways. The concerns range from the nature of accommodations in the region, the extreme & unexpected weather conditions and the size of the group. I also understand that the journey itself can be rough and I may be bared to unseen risks and medical complications that originate at high altitudes, extreme weather and physical exertion.

I hereby confirm that I have a stable health and the required physical exertion will not prove to be fatal for me medically. With self-will, I take responsibility for any injury, personal loss, inconvenience, property damage or even death that may be an outcome of the risks involved with my voluntary participation in this trip.

I affirm that I will abide by all the rules, regulations and instructions provided by the organizers throughout the trip. I acknowledge that the route, schedule and travel plan/details are subject to change by the authorities organizing the trip as required to suit the interest of the travel group in the broader picture.

I apprehend that Earth Voice should not in any way be responsible or liable for any kind of accident, delayed international flights, unexpected cancellation or delays, inconveniences concerned with the travel facilities, any kind of personal or property damage.

I agree that I will readily accept any decision taken by Earth Voice if for any unanticipated reason, the trip is rendered impossible. I agree to understand if I am dropped by Earth Voice from the trip in case I am medically unfit or if there is an omission on my part that breached the travel code and conduct. I admit that Earth Voice can rightfully alter the arrangements made on behalf of the participants and can cancel the entire event if circumstances call for the same without any erstwhile notice.

Since it is a spiritual trip, I acknowledge that I might be abstained from a certain set of things or activities and will have to follow the protocols suggested as a part of spiritual practice.

I promise to channelize my efforts in following the recommended schedule and guidelines. I take responsibility of my experience as I understand that it is dependable on my own actions and I cannot hold Earth Voice, its volunteers or agents responsible for the same.

In consideration of Earth Voice permitting me to be a part of this trip, I, on behalf of myself, my heirs, executors, administrators and assigns, hereby release, discharge, indemnify and hold harmless Earth Voice, its officers, directors, employees, servants, agents and volunteers and each of their heirs, executors, administrators and assigns from any claim, cause of action, costs, attorney’s fees, expenses or demands and all obligation whatsoever arising or that may arise as a consequence of my involvement in this trip due to any cause whatsoever, including carelessness, breach of contract, or breach of any legal or other duty of care, on the part of Earth Voice, and additionally including the failure on the part of Earth Voice to defend or protect me from the risks, perils and dangers of the trip. In case, emergency medical services are deemed obligatory or indispensable, I will be responsible for all the expenses incurred and will not hold Earth Voice responsible for that.

I also give my permission to Earth Voice to use any film or photographic records captured during this trip in commercial campaigning or promotions.

This agreement shall be administered by and inferred exclusively in harmony with the laws of India and no other authority. Any lawsuit concerning the parties to this Agreement shall be brought only within the state of Uttar Pradesh, India and shall be within the exclusive jurisdiction of the courts of India.

I willfully confirm that all the above-mentioned conditions and requirements have been read by me thoroughly. The Agreement has been read and explained to me in a language that I understand. By signing this agreement, I am consciously waiving certain legal rights, which I or my heirs, next of kin, executors, administrators, and representatives may have against earth voice.