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THE ASSUMPTION OF RISK WAIVER AND RELEASE AGREEMENT FOR SOLO DIVING

(Certified Divers with SOLO / Self-Reliant Certification)

You agree to abide by Lake Phoenix policies and have watched the informational video.

TODAY'S DATE: May 18, 2021 VALID UNTIL 31 December 2021

 

LAKE PHOENIX SOLO DIVING STATEMENTS

NOTE: This waiver is NOT VALID Until you also complete your annual

instructor / divemaster or certified diver waiver.

I agree to abide by Lake Phoenix policies and have watched the informational video.

My signature and or initials on this agreement is required as proof that you have completed the other waiver noted above, agree to abide by the safe diving practices therein, and the policies and procedures set in this SOLO diving waiver. 

Diver's initials

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

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First Certified Diver's Name

First Name*

Last Name*

Phone*
First Certified Diver's Date of Birth*
First Certified Diver's Signature*
Parent or Guardian's Email Address

Email*

Confirm Email*
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I am SOLO / Self-Reliant certified by:*

This is a release of your rights to sue.

I am a Certified SOLO / Self Reliant SCUBA Diver and I plan to dive at LAKE PHOENIX in Rawlings, VA.

I, hereby affirm that I am cognizant of all of the inherent dangers of skin and scuba diving, and of the basic rules for underwater activities.

I acknowledge that I am a certified Self-Reliant (solo) Diver trained in safe dive practices and know that scuba diving has inherent risks which may result in serious injury or death. I further acknowledge that choosing to dive without a buddy has additional inherent risks and hazards, including but not limited to, the absence of a buddy to assist me should I experience any problem while diving and the likelihood that others will not be able to affect a timely assist or rescue.

I understand and agree that neither Lake Phoenix nor the dive professional(s) associated with this activity, nor their staff, nor its affiliate and subsidiary corporations, nor any of their respective employees, officers, agents, contractors and assigns (hereinafter "Released Parties"), may be held responsible in any way for any injury, death or other damages to me, my family, estate, heirs or assigns that may occur as a result of my participation in diving activities, or as a result of the negligence of the Released Parties, whether passive or active.

I understand that diving with compressed air involves certain inherent risks including but not limited to decompression sickness, embolism or other hyperbaric/air expansion injury that require treatment in a recompression chamber. I further understand that the scuba diving activities may be conducted at a site that is remote, either by time or distance or both, from such a recompression chamber. I still choose to proceed with these activities in spite of the absence of a recompression chamber in proximity to the dive site(s).  I further understand that by choosing to dive alone, I will not have a buddy to assist me should any of these or other issues occur. 

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

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

I acknowledge that I will be diving without a buddy and it will be my responsibility to plan my dive allowing for my diving limitations and the prevailing water conditions and environment. I will not hold the Released Parties responsible for my failure to safely plan my dive.

I will inspect all of my equipment prior to the activity and will notify the Released Parties if any of my equipment is not working properly. I will not hold the Released Parties responsible for my failure to inspect my equipment prior to diving.  I will be properly equipped for solo diving with safety and redundancy my primary focus. 

I further state that I am of lawful age and legally competent to sign this liability release. I understand the terms herein are contractual and not a mere recital, and that I have signed this Agreement of my own free act and with the knowledge that I hereby agree to waive my legal rights. I further agree that if any provision of this Agreement is found to be unenforceable or invalid, that provision shall be severed from this Agreement. The remainder of this Agreement will then be construed as though the unenforceable provision had never been contained herein.

I understand and agree that I am not only giving up my right to sue the Released Parties but also any rights my heirs, assigns, or beneficiaries may have to sue the Released Parties resulting from my death. I further represent I have the authority to do so and that my heirs, assigns, or beneficiaries will be estopped from claiming otherwise because of my representations to the Released Parties.

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 such as 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 will surrender my SOLO / Self-Reliant diver certification card at the time of entrance into Lake Phoenix and informed the staff at that time of my intent to SOLO dive.  I will sign in and out daily, in the Solo Diving Log provided by Lake Phoenix.  Night SOLO diving (after hours) will only be done with the coordination of the Lake Phoenix Staff.  Failure to abide by any of the Lake Phoenix or Certifying Agencies policies will result in a minimum of the loss of your SOLO diving privileges at Lake Phoenix.

Vehicle operators are responsible for ensuring all individuals regardless of age and activity at Lake Phoenix have completed their waiver and sign in daily.  I and everyone therein have completed their waivers and will watch the Lake Phoenix informational video and abide by all policies therein. Daily sign-in for all divers and non divers.

I, THE UNDERSIGNED, BY THIS INSTRUMENT AGREE TO EXEMPT AND RELEASE ALL RELATED ENTITIES AS DEFINED ABOVE FROM ALL LIABILITY OR RESPONSIBILITY WHATSOEVER FOR PERSONAL INJURY, PROPERTY DAMAGE OR WRONGFUL DEATH HOWEVER CAUSED, INCLUDING BUT NOT LIMITED TO THE NEGLIGENCE OF THE RELEASED PARTIES, WHETHER PASSIVE OR ACTIVE.

I HAVE ALSO FULLY INFORMED MYSELF AND MY HEIRS OF THE CONTENTS OF THIS NON-AGENCY DISCLOSURE AND ACKNOWLDGEMENT AGREEMENT AND LIABILITY RELEASE AND ASSUMPTION OF RISK AGREEMENT BY READING BOTH BEFORE SIGNING BELOW ON BEHALF OF MYSELF AND MY HEIRS.

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

Phone*
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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