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MACE MARINE & TEAM DASH, INC. DBA CONCH REPUBLIC DIVERS VESSEL LIABILITY RELEASE AND WAIVER THIS IS A WAIVER OF YOUR RIGHT TO SUE




1. I understand that the Purpose of Signing This Document Is to Exempt and Release TEAM DASH INC. DBA CONCH REPUBLIC DIVERS (Hereafter Called Dive Store) And REPUBLIC DIVER / AQUATIC DIVER (Hereafter Called Vessel) Its Employees, Agents And Dive Boats Whether Owned, Operated, Leased Or Chartered And To Hold These Entities Harmless From Any And All Liability Arising As A Consequence of Any Act or Omission On Their Part Including, But Not Limited To, Active or Passive Negligence. 

2. I am, by my SIGNATURE, affirming that I am a certified scuba diver or student diver. I have been taught and understand that scuba diving is a hazardous activity with inherent risks and dangers associated therewith including, but not limited to risks associated with equipment failures, perils of the sea and acts of fellow divers which could result in my serious injury or death. BY WAY OF MY SIGNATURE I EXPRESSLY ASSUME THESE RISKS. I assert' that I am physically fit to participate in the sport of scuba diving and snorkeling and I agree by way of my signature that I will not hold any of the above named individuals, persons, or entities responsible if I am injured as a result of any medical conditions while scuba diving and/or snorkeling. I do not have in my possession any illegal drugs, nor am I taking, nor have I recently taken any drugs or medications, which could cause an adverse reaction as a result of combining such drugs and/or medication with scuba diving. 

3. Prior to leaving the dock I will inspect all of my equipment to be used and will notify the dive store of any equipment which I find to not be functioning properly. 1 will not hold the dive store or any of its employees, agents or dive boats, nor the vessel responsible for my failure to inspect my equipment prior to diving. 


4. I will be present and attentive to the safety briefings given by the Divemaster and the Boat Captain. I understand that 1 have an Affirmative Duty to plan and carry out my own dive and to be responsible for my own safety. By way of my signature I expressly agree that I will plan all my dives as no decompression dives, with at least a 3-minute safety stop at 15-feet prior to ascending to the surface. I fully agree that I will start my ascent at the end of each dive with enough air to guarantee being on the vessel with AT LEAST 500 lbs. of air in my tank. Tanks with less than 500 psi will be assessed a VIP fee. 

5. I will immediately abort my dive if:

a. I feel uncomfortable with my diving abilities and/or;

b. Diving conditions are worse than those for which I have been trained, or for which I am comfortable. 

6. I am fully aware and have been trained on the dangers, risks and hazards of holding my breath while diving on compressed air. I fully agree not to hold the above named individuals, entities, or vessels responsible for any such act by me. In the eventuality that I become distressed at the surface, I will IMMEDIATELY drop my weight belt and INFLATE MY BUOYANCY COMPENSATOR. I understand that if I want or need assistance from the vessel, the Divemaster, or Captain I will give the proper "diver in trouble" signal. I understand that this activity may be conducted in a remote site by time and distance from a medical and a re-compression chamber. Nevertheless I expressly wish to proceed with this trip. 

7. By Way Of My Signature On This Document It Is My Express Intention By Way Of This Instrument To Give Up My Right To Sue All Individuals, Or Entities Or Vessels Referred To Herein, Whether Specifically Named Or Not And It Is Also My Intention To Exempt And Relieve The Vessel, Its Employees, Agents And Dive Boats Whether Owned, Operated, Leased Or Chartered, From All Liability As A Consequence Of Any Act Or Omission Including, But Not Limited To, Active Or Passive Negligence. By Way Of My Signature And/ Or Initials On This Document I Fully Agree To Indemnify And Hold These Entities Named Within This Document Harmless From Any And All Liability For Personal Injury Or Any Sort, Property Damage Or Wrongful Death By Myself, Heirs And Assigned, And I Assume Expressly All Risks In Connection With The Activities Or Snorkeling And Scuba Diving. 

8. By Way Of My Signature Given Voluntarily I Evidence That I Have Read And Fully Understand This Document In Its Entirety, if I Have Any Questions With Respect To The Contents Of This Document I Certify That I Have Fully Informed Myself Before Signing My Name Below. 1 Fully Agree To The Terms And Conditions Herein And Realize They Are Given In Exchange For The Dive Store And The Vessel Allowing Me To Participate In This Activity. 

I Understand That This Is An Enforceable Contract.

24 hour Cancellation Policy: Your spot has been reserved for you on our boat. If you do not call 24 hours prior to canceling, your credit card will be charged full price for your dive. 

It is also my intention that this release is continuing in nature and will apply to any injuries or death arising out of or related to any Diving/Snorkeling activities I participate in with the released parties for a period of 1 year after the herein referenced date of my signature. 

September 29, 2022

9. I hereby grant the Team DASH, Inc DBA Conch Republic Divers (furthermore referred to as Conch Republic Divers) permission to use my likeness in a photograph, video, or other digital media (“photo”) in any and all of its publications, including web-based publications, without payment or other consideration. I understand and agree that all photos will become the property of and will not be returned.

I hereby irrevocably authorize the Conch Republic Divers to edit, alter, copy, exhibit, publish, or distribute these photos for any lawful purpose. In addition, I waive any right to inspect or approve the finished product wherein my likeness appears. Additionally, I waive any right to royalties or other compensation arising or related to the use of the photo.

I hereby hold harmless, release, and forever discharge the Conch Republic Divers from all claims, demands, and causes of action which I, my heirs, representatives, executors, administrators, or any other persons acting on my behalf or on behalf of my estate have or may have by reason of this authorization.

I HAVE READ AND UNDERSTAND THE ABOVE PHOTO RELEASE. I AFFIRM THAT I AM AT LEAST 18 YEARS OF AGE, OR, IF I AM UNDER 18 YEARS OF AGE, I HAVE OBTAINED THE REQUIRED CONSENT OF MY PARENTS/GUARDIANS AS EVIDENCED BY THEIR SIGNATURES BELOW. I ACCEPT:





First Participant's Name

First Name*

Middle Name

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Information

Date of last dive (**if >365 days please notify staff): If you are a student put date of last pool session or today's date if going to the pool with our instructor. If you are bubble watching, please put today's date *

Last OCEAN dive (month/year): (if >365 please notify staff)

Certification Level: (If student put "STUDENT", if you are snorkeling put "SNORKELER", if you are bubble watching put "BUBBLE WATCHER") *

Certification Agency & #: (If you are a student, snorkeler, or bubble watcher, please put that in this field to match above) *

Date of last deep dive (>70 feet) (month/year):

Depth:
Based on information provided above do you feel competent to dive, snorkel, or board our boats?*
No
Yes
First Participant's Signature*
Second Participant's Name

First Name*

Middle Name

Last Name*
Second Participant's Date of Birth*
Second Participant's Information

Date of last dive (**if >365 days please notify staff): If you are a student put date of last pool session or today's date if going to the pool with our instructor. If you are bubble watching, please put today's date *

Last OCEAN dive (month/year): (if >365 please notify staff)

Certification Level: (If student put "STUDENT", if you are snorkeling put "SNORKELER", if you are bubble watching put "BUBBLE WATCHER") *

Certification Agency & #: (If you are a student, snorkeler, or bubble watcher, please put that in this field to match above) *

Date of last deep dive (>70 feet) (month/year):

Depth:
Based on information provided above do you feel competent to dive, snorkel, or board our boats?*
No
Yes
Third Participant's Name

First Name*

Middle Name

Last Name*
Third Participant's Date of Birth*
Third Participant's Information

Date of last dive (**if >365 days please notify staff): If you are a student put date of last pool session or today's date if going to the pool with our instructor. If you are bubble watching, please put today's date *

Last OCEAN dive (month/year): (if >365 please notify staff)

Certification Level: (If student put "STUDENT", if you are snorkeling put "SNORKELER", if you are bubble watching put "BUBBLE WATCHER") *

Certification Agency & #: (If you are a student, snorkeler, or bubble watcher, please put that in this field to match above) *

Date of last deep dive (>70 feet) (month/year):

Depth:
Based on information provided above do you feel competent to dive, snorkel, or board our boats?*
No
Yes
Fourth Participant's Name

First Name*

Middle Name

Last Name*
Fourth Participant's Date of Birth*
Fourth Participant's Information

Date of last dive (**if >365 days please notify staff): If you are a student put date of last pool session or today's date if going to the pool with our instructor. If you are bubble watching, please put today's date *

Last OCEAN dive (month/year): (if >365 please notify staff)

Certification Level: (If student put "STUDENT", if you are snorkeling put "SNORKELER", if you are bubble watching put "BUBBLE WATCHER") *

Certification Agency & #: (If you are a student, snorkeler, or bubble watcher, please put that in this field to match above) *

Date of last deep dive (>70 feet) (month/year):

Depth:
Based on information provided above do you feel competent to dive, snorkel, or board our boats?*
No
Yes
Fifth Participant's Name

First Name*

Middle Name

Last Name*
Fifth Participant's Date of Birth*
Fifth Participant's Information

Date of last dive (**if >365 days please notify staff): If you are a student put date of last pool session or today's date if going to the pool with our instructor. If you are bubble watching, please put today's date *

Last OCEAN dive (month/year): (if >365 please notify staff)

Certification Level: (If student put "STUDENT", if you are snorkeling put "SNORKELER", if you are bubble watching put "BUBBLE WATCHER") *

Certification Agency & #: (If you are a student, snorkeler, or bubble watcher, please put that in this field to match above) *

Date of last deep dive (>70 feet) (month/year):

Depth:
Based on information provided above do you feel competent to dive, snorkel, or board our boats?*
No
Yes
Sixth Participant's Name

First Name*

Middle Name

Last Name*
Sixth Participant's Date of Birth*
Sixth Participant's Information

Date of last dive (**if >365 days please notify staff): If you are a student put date of last pool session or today's date if going to the pool with our instructor. If you are bubble watching, please put today's date *

Last OCEAN dive (month/year): (if >365 please notify staff)

Certification Level: (If student put "STUDENT", if you are snorkeling put "SNORKELER", if you are bubble watching put "BUBBLE WATCHER") *

Certification Agency & #: (If you are a student, snorkeler, or bubble watcher, please put that in this field to match above) *

Date of last deep dive (>70 feet) (month/year):

Depth:
Based on information provided above do you feel competent to dive, snorkel, or board our boats?*
No
Yes
Seventh Participant's Name

First Name*

Middle Name

Last Name*
Seventh Participant's Date of Birth*
Seventh Participant's Information

Date of last dive (**if >365 days please notify staff): If you are a student put date of last pool session or today's date if going to the pool with our instructor. If you are bubble watching, please put today's date *

Last OCEAN dive (month/year): (if >365 please notify staff)

Certification Level: (If student put "STUDENT", if you are snorkeling put "SNORKELER", if you are bubble watching put "BUBBLE WATCHER") *

Certification Agency & #: (If you are a student, snorkeler, or bubble watcher, please put that in this field to match above) *

Date of last deep dive (>70 feet) (month/year):

Depth:
Based on information provided above do you feel competent to dive, snorkel, or board our boats?*
No
Yes
Eighth Participant's Name

First Name*

Middle Name

Last Name*
Eighth Participant's Date of Birth*
Eighth Participant's Information

Date of last dive (**if >365 days please notify staff): If you are a student put date of last pool session or today's date if going to the pool with our instructor. If you are bubble watching, please put today's date *

Last OCEAN dive (month/year): (if >365 please notify staff)

Certification Level: (If student put "STUDENT", if you are snorkeling put "SNORKELER", if you are bubble watching put "BUBBLE WATCHER") *

Certification Agency & #: (If you are a student, snorkeler, or bubble watcher, please put that in this field to match above) *

Date of last deep dive (>70 feet) (month/year):

Depth:
Based on information provided above do you feel competent to dive, snorkel, or board our boats?*
No
Yes
Ninth Participant's Name

First Name*

Middle Name

Last Name*
Ninth Participant's Date of Birth*
Ninth Participant's Information

Date of last dive (**if >365 days please notify staff): If you are a student put date of last pool session or today's date if going to the pool with our instructor. If you are bubble watching, please put today's date *

Last OCEAN dive (month/year): (if >365 please notify staff)

Certification Level: (If student put "STUDENT", if you are snorkeling put "SNORKELER", if you are bubble watching put "BUBBLE WATCHER") *

Certification Agency & #: (If you are a student, snorkeler, or bubble watcher, please put that in this field to match above) *

Date of last deep dive (>70 feet) (month/year):

Depth:
Based on information provided above do you feel competent to dive, snorkel, or board our boats?*
No
Yes
Tenth Participant's Name

First Name*

Middle Name

Last Name*
Tenth Participant's Date of Birth*
Tenth Participant's Information

Date of last dive (**if >365 days please notify staff): If you are a student put date of last pool session or today's date if going to the pool with our instructor. If you are bubble watching, please put today's date *

Last OCEAN dive (month/year): (if >365 please notify staff)

Certification Level: (If student put "STUDENT", if you are snorkeling put "SNORKELER", if you are bubble watching put "BUBBLE WATCHER") *

Certification Agency & #: (If you are a student, snorkeler, or bubble watcher, please put that in this field to match above) *

Date of last deep dive (>70 feet) (month/year):

Depth:
Based on information provided above do you feel competent to dive, snorkel, or board our boats?*
No
Yes
Parent or Guardian's Email Address

Email*

Confirm Email*
Check to receive information, news, and discounts by e-mail.
Participant'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:*
Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone Number*
Additional Information

HOW DID YOU HEAR ABOUT CONCH REPUBLIC DIVERS?
  
Please attach Diver Certification Card with highest level of achievement. ***Make sure you upload the side with your name & certification # on it** If you are a student or bubble watcher, please attach a Photo ID or Photo ID of parent if participant is a minor with no ID) *
Valid file types: JPG, GIF, PNG, and PDF
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*

Middle Name

Last Name*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Information

Date of last dive (**if >365 days please notify staff): If you are a student put date of last pool session or today's date if going to the pool with our instructor. If you are bubble watching, please put today's date *

Last OCEAN dive (month/year): (if >365 please notify staff)

Certification Level: (If student put "STUDENT", if you are snorkeling put "SNORKELER", if you are bubble watching put "BUBBLE WATCHER") *

Certification Agency & #: (If you are a student, snorkeler, or bubble watcher, please put that in this field to match above) *

Date of last deep dive (>70 feet) (month/year):

Depth:
Based on information provided above do you feel competent to dive, snorkel, or board our boats?*
No
Yes
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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