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LIABILITY RELEASE FOR SUPERVISION OF CERTIFIED DIVER

First the Good News! This Release is only required once. It is in effect for 1 year for all your activities with Extended Horizons. If you have multiple days booked with us you only need to do this once!

This is A Release For Your Rights To Sue EXTENDED HORIZONS INC. And Its Owners, Employees, Agents, And Assigns For Personal Injuries Or Wrongful Death That May Occur During The Forthcoming Dive Activity As A Result Of The Inherent Risk Associated With Scuba Diving Or As A Result Of Negligence.

Please review each statement in each of the following sections. You must check " I agree" to acknowledge you are aware of the risks.

1. I acknowledge that I am a certified scuba diver trained in safe diving practices.

I Agree

2. I am aware of the risks inherent in this sport, including danger of injury inflicted by marine animals living in a wild environment, and I accept these risks.

I Agree

3. I affirm that I am in good mental and physical fitness for diving. I am not under the influence of alcohol, nor am I under the influence of any drugs that are contradictory to diving. If I am taking medication, I affirm that I have seen a physician and have approval to dive while under the influence of the medication.

I Agree

4. I am aware of the dangers of breath holding while scuba diving and I will not hold EXTENDED HORIZONS INC. and related entities (such as owners, employees, dive masters, boat operators, boat personnel, or diver training agencies) responsible if I am injured doing so.

I Agree

5. I am aware that it is my responsibility to monitor my own air pressure, depth, and time, and to keep myself within safe diving limits appropriate to my skill level and ocean conditions. I will not hold EXTENDED HORIZONS INC. and related entities responsible for any failure on my part to observe safe diving practices which lead to injury.

I Agree

6. I will inspect all of my equipment prior to the activity and will notify boat personnel if any of my equipment (or equipment I am renting) is not working properly. I will not hold EXTENDED HORIZONS INC. and related entities responsible for my failure to inspect my equipment prior to diving.

I Agree

7. I acknowledge that I am physically fit to scuba dive and I will not hold the above listed individuals responsible if I am injured as a result of heart, lung, ear, or circulatory problems, or other illness that occur while diving or snorkeling.

I Agree

8. I understand that even though I follow all of the appropriate dive practices, there is still some risk of my sustaining decompression sickness, embolism, or other hyperbaric injuries. I expressly assume the risk of said injuries.

I Agree

9. I expressly assume the risk and accept all responsibility to plan my dives and dive my plan.

I Agree

10. I understand that scuba diving is a physically strenuous activity and that I will be exerting myself during this diving excursion, and that if I am injured as a result of a heart attack, panic, hyperventilation, etc., I expressly assume the risk of said injuries, and I will not hold the above listed individuals or entities responsible for the same.

I Agree

11. I understand that on this open-water diving trip I will be at a remote site and that there will not be immediate medical care or hyperbaric care available to me and I expressly assume the risk of diving in such a remote spot.

I Agree

12. I am aware of the danger of going to altitude within 12-24 hours after diving either by plane, helicopter, or car and will follow current recommendations and safe practices.    Reminder: Maui's Volcano Summit is at 10,000 feet / 3055 meters

I Agree

It Is The Intention Of The Party filling out this document that by this instrument: To Exempt And Release EXTENDED HORIZONS INC., Its Owners, Employees And All Related Entities As Defined Above, from All Liability Whatsoever, for Personal Injury, Property Damage,Or Wrongful Death Caused By Negligence.

I Agree


I Have Fully Informed Myself Of The Contents Of This Information And Release By Reading It Before I Signed It On the Behalf Of Myself Or My Heirs

I Agree


First Diver's Name
First Name*
Last Name*
Phone*
First Diver's Date of Birth*
Date of Birth
First Diver's Signature*
Second Diver's Name
First Name*
Last Name*
Diver's Date of Birth*
Date of Birth
Third Diver's Name
First Name*
Last Name*
Diver's Date of Birth*
Date of Birth
Fourth Diver's Name
First Name*
Last Name*
Diver's Date of Birth*
Date of Birth
Fifth Diver's Name
First Name*
Last Name*
Diver's Date of Birth*
Date of Birth
Sixth Diver's Name
First Name*
Last Name*
Diver's Date of Birth*
Date of Birth
Seventh Diver's Name
First Name*
Last Name*
Diver's Date of Birth*
Date of Birth
Eighth Diver's Name
First Name*
Last Name*
Diver's Date of Birth*
Date of Birth
Ninth Diver's Name
First Name*
Last Name*
Diver's Date of Birth*
Date of Birth
Tenth Diver's Name
First Name*
Last Name*
Diver's Date of Birth*
Date of Birth
Diver's Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:*
City:*
State/Province:*
Zip/Postal:*
Parent or Guardian's Email Address
Email*
Your signed waiver will be sent to the email address provided here and is available for download for three days via URL attachment.
Emergency Contact
First Name*
Last Name*
Emergency Contact's Phone Number*
Additional Information
Are you diving with a friend or buddy on this excursion?*
What is your friend or buddy's name?
Waiver will remain in effect from date of signing and valid for up to one year.
From: (Today's Date) *
Certification Agency *
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.


By signing below the Parent or Court-Appointed Legal Guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name
First Name*
Last Name*
Relationship*
Phone*
Parent or Guardian's Date of Birth*
Date of Birth
Parent or Guardian's Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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