Heath Care Notice

CLIENT HEALTH INFORMATION PRIVACY DISCLOSURE & CONSENT FORM

(Special Needs, Medical Accommodations & Third-Party Travel Insurance)

1. Purpose of This Form

Waterways Cruise LLC ("Agency," "we," "us," or "our") is dedicated to ensuring your travel experience is safe, accessible, and enjoyable. In the course of arranging cruises, airfare, lodging, excursions, and third-party travel insurance, we may need to collect certain sensitive personal, dietary, or medical information from you or members of your traveling party.

This document outlines how your health-related information is collected, used, shared, and protected, and establishes your voluntary consent for us to do so.

2. Information We May Collect

Depending on your travel arrangements and accommodation requests, we may collect:

  • Dietary Needs: Severe food allergies, religious dietary restrictions, or medical dietary requirements.

  • Mobility & Physical Requirements: Wheelchair/scooter accessibility, oxygen concentrators/tanks, CPAP machines, guide/service animals, or stateroom accessibility requests.

  • Medical Care & Health Conditions: Pre-existing conditions, pregnancy stages, emergency contact medical info, or clearance-to-travel forms required by cruise lines or remote destinations.

  • Travel Insurance & Health Coverage Data: Basic health disclosures required by third-party insurers to assess eligibility, apply for policies, or coordinate pre-existing condition waiver riders.

3. Authorized Disclosure to Third-Party Travel Suppliers

To secure accommodations and confirm bookings on your behalf, you authorize Waterways Cruise LLC to disclose the necessary portions of your health and dietary information to:

  1. Cruise Lines and Vessel Operators: For accessible cabins, medical equipment onboard, dietary coordination with food and beverage teams, and shipboard medical center awareness.

  2. Transportation & Hospitality Providers: Airlines, transfer companies, hotels, and excursion operators requiring safety, mobility, or dietary details.

  3. Emergency Medical Responders: Medical staff, port authorities, or emergency evacuation services in the event of an urgent medical incident during transit.

Waterways Cruise LLC will disclose only the minimum necessary information required to secure the requested service or accommodation.

4. Third-Party Travel Insurance Disclaimer (Not a Licensed Insurance Agent)

Please read the following disclaimer carefully regarding travel and health insurance:

  • Non-Agent Status: Waterways Cruise LLC and its representatives are not licensed insurance agents, brokers, or underwriters. We do not provide licensed advice regarding insurance coverage limits, terms, conditions, or policy exclusions.

  • Third-Party Providers: Any travel protection, health coverage, trip cancellation, or medical evacuation plans offered through or facilitated by Waterways Cruise LLC are underwritten, issued, and administered exclusively by independent third-party insurance providers.

  • Application Facilitation: Any medical or personal information collected by us to assist in quoting or purchasing a third-party policy is gathered solely as an administrative liaison. We are not responsible for underwriting determinations, claims handling, claim approvals, or coverage denials issued by the insurer.

  • Independent Review: You are advised to review the specific policy terms, conditions, exclusions, and pre-existing condition clauses directly with the third-party insurer prior to departure.

5. Confidentiality, Data Security & Retention

Waterways Cruise LLC maintains administrative, physical, and technical safeguards to protect your personal and health information against unauthorized access, loss, or disclosure:

  • Sensitive medical notes are stored within restricted-access booking profiles.

  • Information is retained only as long as necessary to facilitate your travel, assist with post-trip insurance queries (if applicable), or satisfy legal and accounting requirements.

  • We never sell, trade, or rent your sensitive medical, dietary, or personal information to marketing lists or unrelated third parties.

6. Voluntary Provision and Right to Revoke

  • Voluntary: Providing your health, dietary, and accommodation details is entirely voluntary. However, failure to disclose certain requirements (e.g., pregnancy over cruise-line limits, supplemental oxygen, severe allergies) may result in denied boarding or a failure to provide necessary accommodations.

  • Revocation: You have the right to revoke this consent in writing at any time by sending an email to healthcare@waterwayscruise.com. Revocation will apply prospectively and will not affect disclosures already made to confirm active bookings or issued insurance policies.

7. Client Acknowledgment & Authorization

By signing below, I acknowledge and agree to the following:

  1. I have read and understand this Health Information Privacy Disclosure and Consent Form.

  2. I certify that I have the legal authority to provide this information on behalf of myself and any minor or traveling companion included in my booking.

  3. I authorize Waterways Cruise LLC to collect and transmit necessary medical, dietary, and accommodation details to relevant travel suppliers and third-party insurers.

  4. I acknowledge that Waterways Cruise LLC is not a licensed insurance agent or medical provider.


Lead Traveler Name (Printed): __________________________________________________

Date of Birth: ________________________ Booking/Reference #: __________________

Client Signature: _______________________________________ Date: ________________

Email Address: ________________________________________ Phone: ________________

(If signing on behalf of other adult travelers or minors, list their full names below:)

  1. _____________________________________________ 2. _____________________________________________

  2. _____________________________________________ 4. _____________________________________________