Loading...

ProfessionalFull Service Diving Center
Kawaihae Shopping Center
P.O. Box 44940
Kawaihae, Hawaii 96743
(808) 882-7774

KOHALA DIVERS LTD
RIDER / SNORKELER RELEASE FORM

Participant agreement, release and assumption of risk:

This is a release of your rights to sue Kohala Divers Ltd., its employees, agents and boats (whether owned, operated, leased or chartered) for personal injuries or wrongful death that may occur during the forthcoming snorkeling/dive activities as a result of the released parties.

Please agree to each of the following sections:

1. I understand that snorkeling/diving has inherent risks and dangers associated therewith including, but not limited to, risks associated with equipment failure, being struck by surface craft, perils of the sea, acts of fellow divers/snorkelers and I specifically assume such risks of my snorkeling / diving activities whether foreseen or unforeseen.

2. I affirm that I am in good mental and physical fitness for snorkeling and that I am not under the influence of any drugs that are contradictory to snorkeling/skin diving. If I am taking medication, I affirm that I have seen a physician and have approval to snorkel/skin dive under the influence of the medication/drugs.

3. I will inspect all my equipment and the equipment that I am renting from Kohala Divers Ltd or its agents prior to the activity and will notify the above listed individuals if any of my equipment is not working properly. I will not hold Kohala Divers Ltd or any of its employees or agents responsible for my failure to inspect my equipment prior to swimming/snorkeling.

4. I also understand that sea conditions may change while we are en route or on site or at any time during the trip and that this is a function of the environment. I will not hold Kohala Divers Ltd, its employees or its agents responsible for sea conditions that are out of their control.

5. I acknowledge that Kohala Divers Ltd and/or its agents are providing transportation from the dock to a location for me to pursue my in-water activities, and that the captain and the mate or other agents or assigns, while assisting on board the vessel, are not providing me with protection from perils of swimming and snorkeling, and are not responsible for my safety while in the water.

6. I acknowledge that I am physically fit to swim and snorkel. I understand that snorkeling can be a physically strenuous activity and that I will be exerting myself during the snorkeling excursion. I will not hold Kohala Divers Ltd responsible for my safety while in the water.

7. I fully understand and am fully aware that the boat has limited medical facilities and that in the event of an illness or injury, appropriate medical care must be summoned by radio and that the treatment will be delayed until I can be transported to a proper medical care facility.

8. I will not attempt to breathe from a SCUBA regulator provided by a scuba diver while I am snorkeling, and I further understand that such activities can lead to severe injury or death.

9.I hereby grant permission to the rights of my image, likeness or video image without payment or any other consideration. Iunderstand that my image may be edited, copied, exhibited, published or distributed and waive the 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 my image or recording. I also understand that this material may be used in marketing and advertising within an unrestricted geographic area.

10. COVID-19 Policy agreement: I attest that I am not currently ill, not showing symptoms, and not knowingly exposed to COVID-19 or like viruses in the past 14 days. I attest that I have completed any quarantines as required by Hawaii law. I acknowledge the responsibility of lasting lung damage to fellow scuba divers and dive staff if I lie and expose others to COVID-19. I agree to adhere to Kohala Divers, Ltd. Covid-19 policies and the State and County of Hawaii laws including our strict sanitation procedures, mask wearing, and social distancing policies. I release Kohala Divers Ltd, it's employees, agents and dive boats from liability in regards to the transfer of Covid-19 virus. 

 

It is my intention to exempt and release KohalaDivers Ltd, its employees, agents and servants from all liability whatsoever for personal injury, property damage or wrongful death caused by the simple or gross negligence of the released parties.

I have informed myself of the contents of this information and release by reading it before I signed it on behalf of my myself or my heirs.

November 29, 2021

 

First Participant's Name

First Name*

Last Name*
First Participant's 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*
Second Participant's Date of Birth*
Third Participant's Name

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

Last Name*
Tenth Participant's Date of Birth*
Parent or Guardian's Email Address

Email
Receive our newsletter
A signed copy of this waiver will be sent to the email address you provide.
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.
Parent or Guardian's Name

First Name*

Last Name*
Parent or Guardian's 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.


One or more problems exist. Please scroll up.




Powered by  Smartwaiver - TRY IT FREE!