Please print, sign and send the following statement to me with your application and $1,500 deposit:
"I have read the entire Cuisine Course Handbook and Trip Itinerary, and agree to abide by the terms and conditions of le Moulin Bregeon Cuisine Course. In understand that all fees are non-refundable. By consenting to participate in the trip, I absolve the organizers of this trip, Kathryn Gordon, le Moulin Bregeon, Jonathan Robinson, Bernard Levenez, Pascal Merillou, and their associates entirely from all financial and/or other responsibility. My participation in this program is wholly voluntary. In consideration of being allowed to participate in this program, I hereby agree to assume the risks of study abroad, including:
1. Travel: Traveling to and within, and returning from, one or more foreign countries; foreign political, legal, social and economic conditions; different standards of design, safety and maintenance of buildings, public places and conveyances; local medical and weather conditions. There may be risks specific to the host country and I understand that I may access up-to-date information about the host country compiled by the U.S. State Department at http://www.state.gov/travel. I am willing to accept the risks of this travel study program. I understand and acknowledge that le Moulin Bregeon assumes no responsibility or liability, in whole or in part, for any delays, delayed or changed departure or arrival
times, fare changes, airline or vehicle rental reservations, missed carrier connections, sickness,
disease, injuries (including death), losses, damages, weather, strikes, acts of God, circumstances beyond the control of le Moulin Bregeon, force majeure, war, quarantine, civil unrest, public health risks, criminal activity, terrorism, expense, accident, injuries or damage to property, bankruptcies of airlines or other service providers, inconveniences, cessation of operations, mechanical defects, failure or negligence of any nature howsoever caused in connection with any accommodations, restaurant, transportation, or other service or for any substitution of lodging or of common carrier beyond the le Moulin Bregeon's control, with or without notice, or for any additional expenses occasioned by any of the foregoing. If due to weather, flight schedules or other uncontrollable factors I am required to spend additional nights, le Moulin Bregeon will not be responsible for my hotel, transfers, meal costs or other expenses. My baggage and personal property is transported at my risk entirely.
2. Health and Health Insurance: I hereby represent and warrant that I am and will be covered throughout the program by a policy of comprehensive health and accident insurance which provides coverage for injuries and illnesses I sustain or experience overseas, and, more specifically, in the country in which I will be living and/or traveling while in the program. By my signature below, I certify that my health insurance policy will adequately cover me while outside the United States; and I accept all responsibility and liability for any injuries, illnesses, claims, damages, charges, bills and/or expenses I may incur while I am abroad. I understand that I am financially responsible for all of my medical expenses, costs of medical evacuation, and repatriation, whether covered by insurance or not.
I attest that I have no health related condition that precludes my participation in this program.
3. Travel Study Changes: I understand that the le Moulin Bregeon reserves the right to make changes to the travel study itinerary at any time and for any reason, with or without notice, and le Moulin Bregeon shall not be liable for any loss whatsoever to participants by reason of any such cancellation or change. Le Moulin Bregeon is not responsible for penalties assessed by air carriers that may result due to operational and/or itinerary changes. I agree to pay any additional expense resulting from program changes. I accept all responsibility for loss or additional expenses due to delays or other changes in the means of transportation, other services, or sickness, weather, strikes, or other unforeseen causes. If I become detached from the travel study group, fail to meet a departure bus, airplane, or train, or become sick or injured, I will at my own expense seek out, contact, and reach the travel study group at its next available destination.
4. Standards for Conduct: Le Moulin Bregeon reserves the right to decline to accept or retain me in the travel study at any time should my actions or general behavior impede the operation of the travel study or the rights or welfare of any person. Similarly, if my conduct violates any policy or procedure of the
le Moulin Bregeon, I understand that I may be required to leave the program in the sole discretion of le Moulin Bregeon's agents and representatives. In such an event, no refund will be made for any unused portion of the travel study program. I understand that each foreign country has its own laws and standards of acceptable conduct, including dress, manners, morals, politics, drug use and behavior. I will become informed of, and will abide by, all such laws and standards for each country to or through which I will travel during the program. If I leave or am expelled, I consent to being sent
home at my own expense with no refund of fees. I will attend to any legal problems I encounter with any foreign nationals or government of the host country. Le Moulin Bregeon is not responsible for providing any assistance under such circumstances.
5. Assumption of Risk and Release of Claims: Knowing the risks described above, and in consideration of being permitted to participate in the program, I agree, on behalf of family, heirs, assigns, executors and any and all successors in interest, and assume all the risks and responsibilities surrounding my participation in the travel study program. To the maximum extent permitted by law, I release, indemnify, hold harmless and forever discharge Kathryn Gordon, Jonathan Robinson, Bernard Levenez, Pascal Merillou, Le Moulin Bregeon and its agents, employees and representatives from and against any and all liability both for property damage, bodily injury or death including claims, damages, costs, losses, expenses and any liability of any kind arising out of my participation in the above stated travel study.
6. I hereby acknowledge that I have read, understand and will abide by each of the terms and conditions of this Agreement. I understand it is a legal contract and affects any rights I have if I am injured or otherwise suffer damages as a result of participation in this travel study program."
Signature of Participant: ________________________________Dated: ______________
Name (Printed):________________________________________
(No unaccompanied minors are permitted to participate in the course. If you are under 18 years of age, your parent or guardian must sign this Agreement on your behalf. We reserve the right to require proof of age.) The above-named person is under 18 years of age. I am the parent or legal guardian of the above Participant, have read the foregoing Release Form (including such parts as may subject me to personal financial responsibility), am and will be legally responsible for the obligations and acts of the Participant as described in this Release Form, and agree, for myself and for the Participant, to be bound by its terms.
Signature of Parent/Guardian: _________________________________________
Date: ________________________
Revised 2007
CONTACT INFORMATION
Address__________________________________
__________________________________
Email Address ____________________________
Home Phone ____________________________
Business Phone ___________________________
Cell Phone _______________________________
Emergency Contact ________________________
(You will provide your flight information to me at a later date)
