(R) No. 2-15/97-KLU-TD-3611 by Department of Tourism H.P. India)
Bajogi. Vill Siyal, Manali – 175131, Himachal Pradesh, India
Tel: +91 1902 251705, Mob: +91 9816076854
Please mail by post or through scanned email a copy
of this Booking Form and Condition of Contract to POTALA ADVENTURERS with your signature. Use BLOCK CAPITAL throughout.
This is an agreement between POTALA ADVENTURERS hereafter
called the organizer and following people called CLIENTS:
Mr. / Mrs. I Ms.
__________________________________________as it appeared on passport
______________________ Age ______________________________________
Name you like to be called: ________________________________________________________________
City, State, Zip, Pin code: ________________________________________________________________
_________________________ (W) _____________________________
Date of Birth:
________________________ Place of Birth:
Place of Issue
Travel Insurance Name
In Case of Emergency accident Please Notify Supplement
Name Address of Person Whom You Know
_____________________ last name:
____________________________ Mobile No:
Name of trip / trek:
Leaving to trek on
______________________ arriving at final destination on __________________
Thus comprising ___________
actual trekking days.
With ___________ horses. Or with porters ________________________
Arrival Date in New Delhi:
__________________________ From: ________________________
Departure Details from New Delhi:
1. Are you Vegetarian / Non Vegetarian: _____________________________
2. Allergic Health Problem if
Previous Trekking / Climbing Experience if Any: ______________________________
RELEASE OF LIABILITIES AND ASSUMPTION
Please you must insure before commencing trekking, travelling, adventure travel, climbing, any sorts of adventure
activities are not risk free. There is risk of Altitude sickness (AMS acute mountain sickness),
Where medical attention and evacuation may not be available in remote area, injury and death caused by falling
rocks, avalanches, crevasses, while crossing high passes, miss-step falling, land-slides, weather may change to extreme conditions
huge snow-fall, heavy rain, falling from temporary bridges, encounter with wild and domestic animal yak, Dzo, trekking horses/mules
uncertainty caused injury.
These injury or accident are possible if you unaware of it however there are rare chances of injury cause guide
and staff are there for your utmost safety all during the trek and tour.
1. I accept that agency will not be responsible for any accident that may occur during the trekking, or travelling.
2. I accept that agency will not be responsible for any loss of personal nature during the trip.
3. I accept
responsibility for my own welfare any and all risks that may arise in connection with this trip.
4. I accept and acknowledge
that I am voluntary participating on this adventure travel trip.
I understood and state that I have read carefully above given statement and safety
while travelling, trekking or trek climb. Therefore I assume full responsibility of myself, any sorts of accidents injury,
death or loss of personal belongings that occurs with me, POTALA ADVENTURERS, its owner and their staff, employees, associates,
suppliers and affiliated companies, will not be responsible. I am fully in good physical condition and able to take part in
this trekking tours organise by Potala adventurers. The term hereof shall serve as release assumption of risk for me, my heirs,
administrators, and executors and for all members of my family.
I ACCEPT THE RELEASE OF LIABILITIES
I have carefully read this agreement and fully understand
it’s contain. I am aware that this is a release of liabilities and contract between me and Mr. Prem Singh of Potala
Adventurers and or his affiliated organizations and signs it of my own free will. I also acknowledge that I have carefully
read Potala adventurers booking information and including its policy on cancelled trips and refund, and agree to all stated
conditions set forth in the booking information.