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Aqua Native, LLC.
PHOTOGRAPH, FILM, VIDEO AND AUDIO CONSENT AND RELEASE

Aqua Native, LLC. (“Aqua Native”) uses images and sounds of persons Mermaid diving and participating in its programs and events. Aqua Native does not use a person’s likeness, or identify any person by name, unless it has received specific written permission to do so.

In consideration of the above, I hereby grant Aqua Native permission: 

(1) to photograph, film, and make audio and/or video recordings of, myself, and

(2) to use and display the photograph(s), film(s), and audio and/or video recording(s) of me and my likeness, voice, and appearance, in whole or in part, in Dive Utah’s website, archives, and promotional and/or informational material (including, but not limited to, newsletters, brochures, advertisements, and newspaper articles), and in any and all media, broadcast, or digital format, including electronic, radio, internet, and television, throughout the world.

I hereby waive and release any right to compensation for, or ownership of, such photograph(s), film(s), and audio and/or video recording(s) of me and the above uses of them by Aqua Native.

I have read this consent and release and agree to its terms and conditions.

A parent or guardian must sign this consent and release on behalf of a child under the age of 18.

If a parent or guardian participates in a program or event with his or her child, signing on behalf of the child will also indicate that the parent or guardian also consents to the terms and conditions of this consent and release for him or herself.

Date: September 12, 2025

First Participant's Name
First Name*
Last Name*
First Participant's Age Acknowledgment*
First Participant's Date of Birth*
Date of Birth
I certify that I am 18 years of age or older
First Participant's Signature*
Second Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Third Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Fourth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Fifth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Sixth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Seventh Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Eighth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Ninth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Tenth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Parent or Guardian's Email Address
Email*
Confirm Email*
Check to receive information, news, and discounts by e-mail.
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*
Phone*
Parent or Guardian's Age Acknowledgment*
Parent or Guardian's Date of Birth*
Date of Birth
I certify that I am 18 years of age or older
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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