​I am refusing travel insurance for my trip.

The risks for declining coverage have been explained to me by my Travel Advisor. I understand that declining travel insurance mean I will lose all benefits of coverage and I fully accept that risk.

I am aware that my own medical insurance may not cover me outside of the United States.

I UNDERSTAND THAT I WILL NOT BE COVERED FOR:

• Lost luggage
• Missed connections or train delays
• Emergency air lift assistance
• Emergency medical and/or dental assistance
• Emergencies at home affecting me and/or my immediate family (children, grandchildren, aunts, uncles, brothers, sisters, nephews, nieces) 
• Death of myself and/or my immediate family (children, grandchildren, aunts, uncles, brothers, sisters, nephews, nieces)
• Supplier default and/or bankruptcy
• Any other covered circumstances as outlined in the offered travel insurance policy

I understand that I may lose up to 100% of the cost of my cruise/vacation package/travel arrangements, plus any cancellation fees from Brentwood Travel and/or other suppliers, if my trip is cancelled or delayed.

I hereby release Brentwood Travel, its administration, personnel, and my Travel Advisor from responsibility for any consequences, both known and unknown, resulting from my refusal of trip cancellation insurance.

I understand that Brentwood Travel has advised me of the importance of such insurance and I will not hold them responsible for any risks or lost funds. By signing this form, I confirm that I do not expect Brentwood Travel to assist me in any way if my trip is cancelled or delayed for any covered reason.