FOOD ALLERGY DISCLOSURE & LIABILITY WAIVER FORM

Participant Information

Full Name:

Date of Birth:

Phone Number:

E-Mail:

Emergency Contact Name & Phone:

Food Allergy & Dietary Disclosure

Please list all food allergies, intolerances, or dietary restrictions (for example: nuts, dairy, gluten, shellfish, eggs, spices, etc.).

☐ I have no known food allergies or dietary restrictions

☐ I do have food allergies or dietary restrictions, as listed below:

Please describe the severity of your allergy (mild, moderate, severe, anaphylaxis):

Do you carry medication for your allergy (e.g., EpiPen, antihistamines)?

☐ Yes

☐ No

If yes, please specify:

Acknowledgment & Assumption of Risk

I understand that Soul India Journeys LLC, a Washington limited liability company ("Company"), its owners, employees, partners, guides, and vendors will make reasonable efforts to communicate dietary needs to restaurants, hotels, and food providers during my journey(s) organized by the Company (collectively, the "Journeys"). However, I acknowledge that:

Food preparation standards, ingredients, and labeling practices in India may differ from those in the United States;
Cross-contamination in foods during any Journey may occur despite best efforts; and
Company cannot guarantee an allergen-free environment in any Journey.

I voluntarily assume full responsibility for managing my food allergies and dietary needs during any Journey.

Release of Liability

By signing below, I agree to release, waive, and hold harmless the Company, its owners, employees, contractors, and partners from any and all claims, liabilities, losses, damages, or expenses arising from allergic reactions, illness, or injury related to food consumption during any Journey.

I represent and warrant that the information provided herein is true, complete, and accurate.

Participant Signature:

Printed Name:

Date: