SantaLucia Travel, LLC

Travel Request, Disclosure & Consent Form

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Primary Contact Name *

First Name Middle Name Last Name Suffix

Primary Contact Phone Number *

Area Code Phone Number

Primary Contact Phone Type *

Home Mobile Work

Secondary Phone Number

Area Code Phone Number

Secondary Phone Type

Home Mobile Work

Primary Contact E-mail *

Secondary E-mail

Travel Information:

Departure Airport

Destination *

Date of Departure

Month Day Year

Date of Return

Month Day Year

Type of Travel Requested (check multiple fields if applicable) *

Cruise Air Hotel Car Rental

If Cruise What type of Cabin do you prefer? (check multiple fields if applicable) *

Not Applicable Interior Oceanview Balcony/Verandah Minisuite/Junior Suite Suite

# of Guests in your Party *

1 2 3 4

What is your approximate budget range (per guest)? *

Please describe the Travel you're Requesting (i.e. specific cruise, resort, hotel, part of a group (if so which), etc. *

Passenger Names: (Please List Full Legal Names EXACTLY as they appear on your Passports or other approved Government Issued ID you will be using for travel)

If additional space is needed use the space located in the Comments box near the end of this form.

Passenger 1 *

Prefix First Name Middle Name Last Name Suffix

Passenger 1 Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

Passenger 1 Birth Date *

Month Day Year

Passenger 1 Gender *

Passenger 1 Email *

Passenger 1 Phone

Area Code Phone Number

Passenger 1 Phone Type *

Home Mobile Work

Passenger 1 Citizenship *

United States of America Canada

Passenger 1 Trusted Traveler Number (i.e. Global Entry, NEXUS, TSA Pre-Check (if applicable)

Enter your Global Entry, NEXUS or TSA Pre-Check Trusted Traveler #

Passenger 1 Passport Number

Enter Passenger 1's Passport Number

Passenger 1 Passport Issuing Country

United States of America Canada

Passenger 1 Passport Issued Date

Month Day Year

Passenger 1 Passport Expiration Date

Month Day Year

Passenger 1 Emergency Contact Name *

First Name Last Name Relationship

Passenger 1 Emergency Phone *

Area Code Phone Number

Does Passenger 1 have any Special Needs such as dietary, diabetic, sharps, CPAP, mobility, accessibility, etc)? *

Passenger 2 (if applicable)

Prefix First Name Middle Name Last Name Suffix

Passenger 2 Address (Type SAME on Street Address line if same as Passenger 1)

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

Passenger 2 Birth Date

Month Day Year

Passenger 2 Gender

Passenger 2 Email

Passenger 2 Phone

Area Code Phone Number

Passenger 2 Phone Type

Home Mobile Work

Passenger 2 Citizenship

United States of America Canada

Passenger 2 Trusted Traveler Number (i.e. Global Entry, NEXUS, TSA Pre-Check (if applicable)

Enter your Global Entry, NEXUS or TSA Pre-Check Trusted Traveler #

Passenger 2 Passport Number

Enter Passenger 2's Passport Number

Passenger 2 Passport Issuing Country

United States of America Canada

Passenger 2 Passport Issued Date

Month Day Year

Passenger 2 Passport Expiration Date

Month Day Year

Passenger 2 Emergency Contact Name

First Name Last Name Relationship

Passenger 2 Emergency Phone

Area Code Phone Number

Does Passenger 2 have any Special Needs such as dietary, diabetic, sharps, CPAP, mobility, accessibility, etc)?

Passenger 3 (if applicable)

Prefix First Name Middle Name Last Name Suffix

Passenger 3 Address (Type SAME on Street Address line if same as Passenger 1)

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

Passenger 3 Birth Date

Month Day Year

Passenger 3 Gender

Passenger 3 Email

Passenger 3 Phone

Area Code Phone Number

Passenger 3 Phone Type

Home Mobile Work

Passenger 3 Citizenship

United States of America Canada

Passenger 3 Trusted Traveler Number (i.e. Global Entry, NEXUS, TSA Pre-Check (if applicable)

Enter your Global Entry, NEXUS or TSA Pre-Check Trusted Traveler #

Passenger 3 Passport Number

Enter Passenger 3's Passport Number

Passenger 3 Passport Issuing Country

United States of America Canada

Passenger 3 Passport Issued Date

Month Day Year

Passenger 3 Passport Expiration Date

Month Day Year

Passenger 3 Emergency Contact

First Name Last Name Relationship

Passenger 3 Emergency Phone

Area Code Phone Number

Does Passenger 3 have any Special Needs such as dietary, diabetic, sharps, CPAP, mobility, accessibility, etc)?

Passenger 4 (if applicable)

Prefix First Name Middle Name Last Name Suffix

Passenger 4 Address (Type SAME on Street Address line if same as Passenger 1)

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

Passenger 4 Birth Date

Month Day Year

Passenger 4 Gender

Passenger 4 Email

Passenger 4 Phone

Area Code Phone Number

Passenger 4 Phone Type

Home Mobile Work

Passenger 4 Citizenship

United States of America Canada

Passenger 4 Trusted Traveler Number (i.e. Global Entry, NEXUS, TSA Pre-Check (if applicable)

Enter your Global Entry, NEXUS or TSA Pre-Check Trusted Traveler #

Passenger 4 Passport Number

Enter Passenger 4's Passport Number

Passenger 4 Passport Issuing Country

United States of America Canada

Passenger 4 Passport Issued Date

Month Day Year

Passenger 4 Passport Expiration Date

Month Day Year

Passenger 4 Emergency Contact Name

First Name Last Name Relationship

Passenger 4 Emergency Phone

Area Code Phone Number

Does Passenger 4 have any Special Needs such as dietary, diabetic, sharps, CPAP, mobility, accessibility, etc)?

All names and dates of birth listed above are as they appear on the respective government issued identification for each named person *

I agree

Travel Insurance:

Travel Insurance is recommended, particularly for International Travel. Please indicate if you would like a quote, preder to decline, or would like a quote for just some of the passengers (if so select Other and indicate who). *

Request Quote for ALL Passengers Decline

I have been advised of the option to purchase travel insurance. *

I agree and understand that my investment is at risk if insurance is not purchased.

Additional Comments or Passenger Information

I agree to the accuracy of the information I have entered within this form and take full responsibility for any errors in the data I have entered. *

I agree

Passenger Documentation and Admissibility Disclosure, Consent and Waiver of Liability

Responsibility: SantaLucia Travel, LLC acts only as an agent for airlines, hotels, tour operators, and other suppliers of services and shall not be held responsible for any injury, loss or damage caused by accident or event beyond their control, or by any action or negligence of any persons who are not in their employ.

SantaLucia Travel, LLC can accept no responsibility for losses or additional expenses due to improper documentation, inadmissability to any country (including Canada), delay or changes in air, sea or other services due to sickness, weather, strike,war, or other causes. The right is reserved to make adjustments in the itinerary if deemed necessary. Prices are accurate at time of quote and are subject to change until trip is paid in full.

Admissibility to Canada Advisory: Under Canadian law, those who have ever been convicted of even a minor criminal offense (such as DUI or dangerous driving) may be denied entry to Canada by Canadian customs and immigration officials. Such individuals may be deemed rehabilitated if they meet Canada's requirements contained in the Immigration and Refugee Protection Act. In some cases, individuals with criminal records may be admitted to Canada depending on the nature of the offense and the time elapsed since the transgression was committed or since sentencing.

Please visit www.cic.gc.ca/english/helpcenter (Citizen and Immigration for Canada) and typed "inadmissibility" in the search box for specific detail that might concern your admission to this country.

Other countries may have similar admissibility restrictions as Canada, paricularly for those who may have a past criminal record of any kind (regardless of how old). We recommend you visit the state department website for each country you may be visiting to review their admissibility requirements and seek legal counsel if necessary prior to booking any travel out of the country.

Passports: All international trips require a Passport Book valid for at least 6 months beyond the date of departure. Any and all additional Visas or travel documents required are the responsibility of the traveler.

As of June 1, 2009, a valid Passport will be required for everyone in your party, regardless of age, for all travel outside of the United States. You understand that a passport card and other WHTI compliant government ID and/or birth certificate’s are only valid for land & sea travel (closed loop originitating and ending in the same US port) between the US & Canada, Mexico, the Caribbean region & Bermuda. They are NOT acceptable for any international air travel to or from the United States. A Passport BOOK is the ONLY accepted document for international air travel. We strongly urge you and your party to obtain passport books for your upcoming travel, as you will need them in case of several potential scenarios such as, missing the ship either in the port of departure, or interim ports during the itinerary or if a medical emergency arises

Having the proper documentation is the sole responsibility of the traveler.
Travelers who fail to present the necessary documentation, will be denied boarding, and be solely responsible for all fines, cancellation penalties, fees and additional expenses. Travel Insurance will not reimburse anyone for their travel expenses, if they're denied boarding for not having a valid passport and/or proper documentation.

Your passport book should not expire for at least six (6) months, following the return of your travel.

Following are links to websites that you should investigate to thoroughly understand the use of passports:

Western Hemisphere Travel Initiative: This site outlines the use of passport cards vs passport books:
http://www.cbp.gov/travel/us-citizens/western-hemisphere-travel-initiative
Apply for a Passport: This site has detailed information about your passport:
http://www.travel.state.gov/passport/passport_1738.html
Do you need a Visa? Click this link and enter the country(ies) you're visiting to see if a Visa is required: https://travel.state.gov/content/passports/en/country.html

Air Travel: Flight details including departure times are always subject to change by the airlines and are not under the control of SantaLucia Travel.

REAL ID ACT:
The Transportation Security Administration (TSA) is reminding travelers that beginning October 1, 2021, every traveler must present a REAL ID-compliant driver’s license, or another acceptable form of identification, to fly within the United States. TSA has launched a public awareness campaign about the upcoming identification changes to ensure that every traveler is prepared for the airport security checkpoint process when the REAL ID Act goes into full enforcement. For more information, visit https://www.dhs.gov/real-id-public-faqs

Cancellations: Cancellation, revision and refund polices for changes or unused travel/components vary and are subject to the policies of each supplier. Cancellation penalties can range up to 100% depending on how close to departure the written notification is received. Air, insurance premium and no-shows are always non-refundable.

Travel Insurance: SantaLucia Travel, LLC recommends the purchase of Travel Protection that can help minimize the monetary loss incurred due to unforseen events beyond your control such as: cancellation, missed connections, baggage loss, trip delay, and especially medical emergencies. Quotes and coverage options will be provided if requested above.

Following is a statement made by the below signed individual on behalf of the entire party traveling with them.

My signature below, confirms that I have read the Passenger Documentation and Admissibility Disclosure, Consent and Waiver of Liability terms above, and I understand that I will assume all responsibility for myself and all members of my traveling party for any penalties, fines and additional expenses, should I not provide proper documentation or be deemed inadmissible for entry to any country on my itinerary for my/our travel. Neither the applicable travel supplier, cruise line, airline, insurance provider, nor SantaLucia Travel will be held liable for any damages I may incur for my decision, nor will they be required to offer, or provide a refund of any kind.

SantaLucia Travel, LLC has disclosed the potential situations for using a passport card or other Western Hemisphere Travel Initiative (WHTI) compliant government ID and/or birth certificate in lieu of a passport book and answered all questions regarding the practice. SantaLucia Travel, LLC has offered advice to obtain a passport book for all travel outside of the United States. By signing this Waiver of Liability, SantaLucia Travel is released from any liability, which may be incurred by failing to obtain a passport book.
SantaLucia Travel, LLC has disclosed the Real ID Act requirements and my responsibility to obtain sufficient documentation for travel within the United States.
SantaLucia Travel, LLC has disclosed the potential situations where I may be deemed inadmissible for enty into other countries outside the United States . SantaLucia Travel has offered advice on how to check on my admissibility to countried outside of the United States. By signing this Waiver of Liability, SantaLucia Travel shall be held harmless and is released from any liability, which may be incurred for being denied admissibility to any country on my itinerary.
I understand that INTERNATIONAL AIR travel requires a valid PASSPORT BOOK (that does not expire for at least six months, following the return of travel, and that other forms of ID such as enhanced Driver's Licenses, Passport Cards, NEXUS, SENTRI, etc. are NOT valid forms of identification for flights to or from the United States and international destinations.

I agree to the Disclosure and Admissibility Consent and Waiver of Liability Terms above. *

I agree

Change/Cancellation:

I have been advised of potential change/cancellation charges that may be implemented by the supplier in the event that I choose to cancel or change my booking after making the initial deposit. *

I agree

By signing in the box below, I expressly acknowledge my acceptance of the accuracy of the information I have entered as well as my acceptance of all terms above.

I agree to this being my signature by electronic transfer to SantaLucia Travel, LLC.

Sign using a mouse, or if using a device with a touch screen, use your finger or a stylus.

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SANTALUCIA TRAVEL, LLC
an independent affiliate of Nexion Travel Group

3456 Parkwood Cmn
Hamburg, NY 14075

getaway@santaluciatravel.com

(716) 481-8823

Note: If you'd like to make a payment on your reservation please complete our Credit Card Authorization Form which can be located at the preceding link.