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INSTRUCTOR or DIVEMASTER AGREEMENT

TODAY'S DATE: November 21, 2024 VALID UNTIL 01 January 2025

WITNESS the following conditions to use Lake Phoenix when teaching:

I certify that I meet my agency's instructor or divemaster requirements. When teaching will have current membership and liability insurance with my scuba agency (Combined Single Limit $1,000,000 per occurance).

I agree to abide by the policies of my agency and Lake Phoenix regarding the maximum student-Instructor ratio for in water training for entry level divers and all other diver training or when leading activities for recreational scuba diving.

I agree to hold harmless Lake Phoenix and its agents for all activities for which I am responsible, and to assume full responsibility for these activities, when conducted under my supervision at Lake Phoenix.

Lake Phoenix is recognized as an additional insured with my insurance carrier.

I will ensure a Lake Phoenix on-line liability release and assumption of risk agreement waiver has been completed by every diver, swimmer, and visitor in my group.

I agree to supply my own first aid supplies including emergency O2 when supervising an activity at Lake Phoenix.

I agree to ensure everyone in my group has been made aware of Lake Phoenix's park rules and regulations, terms of service and conditions and have watched the INFOMATIONAL and POLICY VIDEO found on Lake Phoenix's website; and sign in DAILY.

I am responsible for the activities of those within my group. I will ensure everyone is listed on my manifest regardless of age or activity and sign in daily. Please get this to us in advance to assist in a quick entrance to the park.

I consent and agree that any photos, videos or likeness taken or captured by Lake Phoenix staff, their equipment or their agents can be used as Lake Phoenix management or staff requires. This includes, but is not limited to, website, flyers, posters, news alerts and on-line media. I understand that Lake Phoenix is the legal copyright owner.

WITNESS the following conditions to use Lake Phoenix when diving:

I understand and agree that the purpose of my diving activities are strictly recreational, and that it is not the function of the staff of Lake Phoenix or any of the diving leaders employed by Lake Phoenix, to serve as the guardian(s) of my safety.

I agree to furnish my own equipment and be responsible for its good operating condition, regardless of where I obtain it. I further agree that prior to each dive I will check my own equipment and my buddy's equipment to ensure proper function, completeness and familiarity, and do not expect my equipment to be inspected by the staff of Lake Phoenix.

I understand my diving leader(s) or Lake Phoenix staff may provide advice or assistance to me, and I agree to hold harmless Lake Phoenix or any of its agents, staff, or leader(s) for any of their actions in attempting to be of assistance to me. I do not expect Lake Phoenix or its agents to supervise or control my diving activities in any way. BY SIGNING THIS DOCUMENT, I ASSUME ALL RESPONSIBILITY FOR MY ACTIONS, PERSONAL INJURY, PROPERTY DAMAGE OR WRONGFUL DEATH, even if caused by the negligence of Lake Phoenix staff or agents.

I further understand that skin and scuba diving are physically strenuous activities, and that I can exert myself by participating in these activities. IF I AM INJURED IN ANY WAY FROMCAUSES INCLUDING BUT NOT LIMITED TO,HEART ATTACK, PANIC, HYPERVENTILATION OR DROWNING, I EXPRESSLY ASSUME ALL RISK OF THESE INJURIES, AND IN DOING SO, I EXEMPT AND RELEASE LAKE PHOENIX, OR ANY OF ITS STAFF OR AGENTS, FROM ALL LIABILITY OR RESPONSIBILITY RESULTING FROM MY PARTICIPATION IN SKIN AND SCUBA DIVING.

I am aware that Lake Phoenix is considered to be a remote diving location, and as a result, I further understand it can take EMERGENCY MEDICAL SERVICES an extended period of time to respond when called. However, it is my decision to skin and scuba dive at Lake Phoenix knowing these facts and limitations.

I have read, understand and agree to abide by the RULES OF LAKE PHOENIX and the STANDARD SCUBA DIVING PRACTICES during my recreational diving activities.

I understand and agree that I am participating in these recreational diving activities voluntarily, and I agree to be completely responsible for my own actions. I understand there are living creatures which inhabit the lake which include but not limited to, fish, turtles, and an endangered species of the northern water snake (no fangs and non-poisonous). I have been warned of the danger of fish and animal feeding or harassment because these creatures can bite.

I hereby declare that I am of legal age and am competent to sign this waiver and release agreement.

LAKE PHOENIX STANDARD SCUBA DIVING PRACTICES

Scuba Diving is dangerous, so to minimize your risk, you as a diver should:

Be trained in scuba diving by a certified open water instructor and certified by a nationally recognized certifying

organization.

Maintain good physical and mental condition for diving. Only dive when feeling well. DO NOT USE ANY INTOXICATING OR DANGEROUS DRUGS BEFORE DIVING. Get a regular medical examination for scuba diving.

Use reliable, complete and well maintained diving equipment which you check before each dive. You will deny the use of your equipment to a non-certified diver unless you are an instructor and the individual is your student. When scuba diving in Lake Phoenix, use a functional buoyancy controlling device (BCD) plus a submersible pressure gauge and all other equipment as required by your certifying agency.

Know the limitations of yourself, your buddy and your equipment. Use the best possible judgment and common sense in planning each dive. Allow a margin of safety in order to be prepared for emergencies. Set moderate limits for depth and time in the water. Enter overhead environment only if properly trained e.g. cavern, cave or wreck specialty.

Be familiar with this dive site. If not, obtain a formal diving orientation and/or purchase a lake topographical map from the divemaster or attendant on duty.

Control your buoyancy to make diving as easy as possible. Be prepared to clear your mask, mouthpiece, or take other emergency action if needed. In an emergency: STOP, BREATH, THINK, and TAKE CONTROL THEN, TAKE ACTION.

Never dive alone. Always buddy dive - know each other's equipment. Know and review hand signals and stay in close contact with your buddy. Together plan your dive and then dive your plan.

Use a float or kayak as a surface support station whenever appropriate. Fly the dive flag to warn other kayakers divers are in and under the water. Slowly surface close to the float and flag, watching and listening for possible hazards. Flags not required for diving at Lake Phoenix.

Beware of breath holding. Breathe continuously throughout a scuba dive. Exhale during any ascent. Know your limits and allow for a margin of safety. Be sure to equalize pressure early and often both during ascent and descent.

If you are cold, tired, injured, low on air or not feeling well, then get out of the water. Diving is more risky and no longer enjoyable at that point. If any abnormality persists, get medical attention.

Know decompression procedures, tables and emergency procedures as established by your scuba agency. Make all scuba dives within no decompression limits for the depth you dive.

Continue your scuba training by taking advanced open water or specialty courses. Log your dives and try to make at least 12 dives each year. BE A RESPONSIBLE DIVER.

NOTE: Your signature on this agreement was required as proof that you were made aware of these STANDARD SAFE SCUBA DIVING PRACTICES.

I HAVE READ THIS AGREEMENT, I UNDERSTAND IT, AND I AGREE TO BE BOUND BY IT.

I Agree

Lake Phoenix | 1 Quarry Lane, Rawlings VA | 23876 | Phone: (804) 716-2199


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STATEMENT OF QUALIFICATION
I am a certified:*

authorized to teach or lead scuba diving by:


Agency Name: *

Agency Number: *
STATEMENT OF PURPOSE
I plan to use Lake Phoenix for the purpose of: *
Pleasure
Teaching
Camping
Other

If Other, please list:
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*

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Parent or Guardian's 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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