Reservation/Release of Liability Form


For reservation information, please call (France)011-33-565-24-63-24 (fax)011-33-565-36-59-05 (USA)513-533-0511, leave message, or email us at hautbaran@aol.com. Mail reservation form and deposit to P.O. Box 337, North Bend, Ohio 45052. Webpage www.hautbaran.com


Trip Information


Trip requested______________Departure date______________ Trip cost_________________


                            Complete the information below for each person :

Name__________________________________  *  Name__________________________________
Date of birth________________________ M  F  *  Date of birth________________________ M  F
Address________________________________  *  Address________________________________
City___________________State____Zip_____  *  City___________________State____Zip_____
Country_______________Phone____________  *  Country_______________Phone____________
Email__________________________________  *  Email__________________________________
Height/Weight____________ Riding Skill, 1 2 3 4  *  Height/Weight____________ Riding Skill, 1 2 3 4

Equipment Rental: Bikes are Giant or Peugeot road bikes with 3x7 shimano shift or equivalent. Bikes come with classic pedals (no clips), helmet, water bottle and bottle rack, pump, repair kit, anti-theft and lights if desired. If you are a serious rider we recommend bringing your own clipless pedals to swap out for the classic pedals, and to bring your own helmet for a more custom feel. If you are a very serious rider, we highly recommend bringing your own custom bike. Shoes and all-weather attire are not provided.


I would like to rent a bike, Y  N - Number of bikes wanted________________.


Accommodations : If you are a couple would you prefer a room with 2 beds or  1 large bed. All single guests will share a room with twin beds. Single supplement is $500.00 USD.


Deposits : $500.00 USD per person x number of participants =   _______________ total deposit. Deposits can be paid by personal check or money order, payable to William Haas or Rosalie Haas, P.O. Box 337 North Bend Ohio, 45052.


Balance : The balance of your trip is due 90 days prior to departure and may be paid by check or money order. If final payment is not received when due, we reserve the right to cancel the reservation. Prices are in USD and are good for the 2005 season. Prices cover land costs only and not airfare.


Cancellation/refund : Cancellation fees are determined accordingly : 91 days prior to trip $100.00 USD; 61-90 days prior to trip 25% trip price; 31-60 days prior to trip 50% trip price; 0-30 days prior to trip no refund. Exceptions cannot be made for any reason and there is no refund for arriving late or leaving a trip early. If we must cancel a trip, all payments received to date will be refunded and this constitutes full settlement. We are not responsible for expenses incurred in preparation for any trips (even cancelled trips), such as airline tickets, travel delays, flight cancellations or health problems. Travel Insurance is highly recommended and should be arranged through your travel agency.


Release of Liability/Assumption of all risks: Domaine du Haut Baran and their employees, affiliates, successors, or assigns is not liable for any negligent or willfull act or failure to act of any person, third party or entity which is to, or provides goods or services including; transportationcompanies, equipment suppliers, food service providers etc . I acknowledge that I have voluntarily applied to participate in the trip I have described on this application. I am voluntarily participating in this trip with the knowledge of the inherent risks and dangers involved including but not limited to negligence on the part of DDHB, physical exertion, forces of nature, transportation failures, consumption of alcohol, risks with food or impure water, civil unrest terrorism, criminal activity, wild or other animals, failure of equipment, accident or illness without means of rapid evac, or avail of medical suppl or services, adequacy of medical attention once provided, and stolen/lost/or misplaced luggage or property. I acknowledge that bicycle travel has inherent risks, and that I am participating in this trip, giving full consideration to these risks. I hereby agree to be responsible for my own welfare and accept any and all risks of delay, unanticipated events, inconvenience, illness, injury, emotional trauma or death. I hereby release and discharge forever DDHB and their employees from and against any and all liability arising from my participation in this trip. I agree that this release is legally binding upon me, all members of my family and all minors travelling with me, my and their heirs, successors, assigns, and legal reps, it being my intention to release DDHB, their employees, successors, affiliates, and assigns from any and all liabilities to the max extent by law. I acknowledge that to participate, I will require a legal passport, and that DDHB reserves the right to remove me or any participant it judges as incapofmeeting the rigors of activities or who it determines to detract from the enjoyment of the trip by others. I will follow all safety rules presented to me either written or oral by DDHB.

 


____________________________________________________     ___________________________________________________

                                         Signature                                                                                              Signature