Loading...

Participation Application and Liability Release Waiver for Scuba X Travel

 

 

Please be advised that you are completing aGroupTrip Waiver or Participation Application

and Agreement for Services from Scuba X Travel, Inc.

GENERAL RELEASE, ASSUMPTION OF RISK, WAIVER OF LIABILITY AND INDEMNITY AGREEMENT

I hereby certify that all of the statements made herein regarding my history and experience are true and correct.  I acknowledge that my acceptance as a participant on this trip is predicated on my personal assurance that I am mentally and emotionally, as well as physically fit and able, to engage in the activities associated with this trip itinerary, most often, but not limited to, some form of adventure activity or water-related sports activity.  This can include, but is in no way limited to, snorkeling, swimming, wading, beachgoing, dive training and practice in a confined water setting, non-confined water training or activities such as scuba diving in the ocean, a lake or quarry (collectively herein referred to as "scuba diving") and that I have had sufficient training to engage in all scuba diving activities that I choose to participate in.  I fully understand that scuba diving can be both dangerous and hazardous.  I am fully aware of and understand the inherent risks associated with scuba diving and other water-related sports or activities, due to both known and unknown causes.  I voluntarily assume ALL risk of loss, damage, injury and even death, that I may sustain, while engaged in said activities associated with Scuba X Travel, Inc., and / or Aquatic Outfitters, Inc. dba Scuba Schools of America (this secondarily-listed released member will herein be referred to as "SSA") and any related scuba diving, water sports activity, and / or travel program and those associated activities, whether water-related or not, organized by or affiliated with either of the above-mentioned parties.

I, as the applicant, along with my personal representatives, assigns, heirs and next of kin, do hereby forever release, waive and discharge Scuba X Travel, Inc., SSA, Nicolena D.V. Berry, Russell Berry, as well as any agents or employees, representatives, contractors or associates of the aforementioned hereinafter collectively referred to as "releasees", from any and all liability.  I, along with my personal representatives, assigns, heirs and next of kin release said releasees from ALL LOSS OR DAMAGE and any claims or demands therefore, on account of injury to my person or property or resulting in my death, WHETHER CAUSED BY THE NEGLIGENCE OF THE RELEASEES or otherwise, while engaged in a Scuba X Travel, Inc. or SSA scuba diving or travel program, regardless of whether the nature of the extent of such a loss, injury or damage cannot be ascertained until some future date or time.  I, along with my personal representatives, assigns, heirs and next of kin swear to not bring any action against releasees arising out of any such damage or loss.

I warrant that any and all statements made on any completed forms, Guest Profiles and waivers such as this SXT Participation Application and Liability Release are herein true and correct.  I further understand that the releasees will rely on such statements and they they will act as an inducement to Scuba X Travel, Inc., and / or SSA in accepting my application for participation in any of the scuba diving, water-based and non-water-based activities and / or travel programs and all activities and situations arising from such participation.

I understand that the releasees reserve the right to refuse or deny participation to any applicant for any reason whatsoever.  I also understand that the releasees reserve the right to terminate any or all portions of any travel itinerary or program at any time, should I fail to act appropriately with regards to my own personal safety and / or the safety of other individuals participating in any or all activities associated with the releasees scuba diving and / or travel programs, regardless of whether such activity is hosted or maintained by the releasees.  This determination of appropriateness in my actions and behavior shall be at the professional discretion of the releasees or their representatives.  If at any time I choose to threaten, harass, physically assault or endanger the safety or well being of other participants, I understand that part, or all, of my travel itinerary and ability to continue to participate may be terminated, with no financial recourse and no right to make any claim for monetary compensation, or otherwise.  Further, should my inappropriate behavior disrupt the group travel itinerary, I understand that I may become liable for additional incurred expenses.

It is fully understood that Scuba X Travel, Inc. and SSA are independent of and have no business association as partner, joint venture, owner or otherwise with any resort, hotel, transportation carrier, boat, tour or activity operator, or other person or firm, furnishing any service or facility in connection with the subject travel program.

It is further understood that the remoteness of area, local custom and prevailing weather conditions may cause substitutions of facilities and / or equipment, inconvenience or modification to any or all portions of the travel itinerary.  Scuba X Travel and / or SSA reserves the right to modify and / or cancel any arrangements due to unfavorable weather conditions, or any other conditions, which warrant such modifications or cancellation.  The use of equipment or service, including resorts, captains and shipboard personnel may change at any time.  It is therefor understood and agreed upon that all said releasees make no warranty and assume no responsibility or liability for such substitutions, modifications or cancellations.

The releasees reserve the right to cancel any scheduled trip at any time.  No refunds can be made for cancelled diving arrangements due to adverse weather conditions, or for the substitution of facilities, personnel and / or equipment, or for resultant inconvenience.  As a professional entity, Scuba X Travel and / or SSA will, in its best efforts available, will make comparable and suitable substitutions in order to maximize the return on any travel investment by members of the travel itinerary.

I, as applicant, do hereby indemnify and agree to hold Scuba X Travel, Inc. and SSA, and all releasees, agents or representatives from any and all claims, suits, liability, injuries, losses and damage to any person which arise out of my participation in a releasee scuba diving and / or travel program, or from my withdrawal, cancellation or expulsion from a Scuba X Travel, Inc. or SSA scuba diving or travel program.

I understand that any or all of the aforementioned releasees will not be responsible for any financial disappointment or loss caused by reasons outside of the control of Scuba X Travel, Inc. or SSA or any and all of the releasees.  This may include, but is in no way limited to, my own personal health or medical condition(s) or the health or medical comdition(s) of a family member or other person known to me, resulting in my inability to participate in the subject activity or travel program.  Deposits and payments for trip participation are non-refundable.  No refunds of any kind will be made to participants that decide to cancel or modify any or all portion(s) of any travel itinerary.

I am fully aware that Scuba X Travel and SSA strongly recommend travel and, when applicable, scuba diving or related insurance.  Unless specifically stated as REQUIRED in official documentation, I may choose to decline purchasing travel insurance. I do so at my own risk. Further, I understand that should I choose to purchase a travel, dive or other activity insurance policy, Scuba X Travel, SSA and any and all of the releasees bear no responsibility for my failure to obtain the proper type of insurance necessary for my own individual needs, nor are they responsible for my failure to obtain high enough coverage limitation amounts or policy inclusion items that may result in my loss of recovery of monies or other goods or items of value, in the event a claim is filed and, but not necessarily, rejected. It is my sole responsibility to read and understand all portions of the policy, including disclaimers, policy limits, exclusions and conditions that may render any or all of my claim invalid or any or all items not able to be covered. This can include, but is not limited to, Cancel for Any Reason, Cancellation, Interruption and any time-of-deposit vs claim submission or policy purchase timelines. 

I understand that this application form and general release, assumption of risk, waiver of liability and indemnity agreement signed by me, the applicant, and by the parent or guardian of any minor applicant is in all respects, subject to the terms and conditions above, which have been read in their entirety and are unconditionally agreed upon.  I, or the minor applicant and the parent or guardian, further agree to observe strictly and comply with such reasonable terms and regulations as the releasees may, from time to time, deem desirable or necessary to prescribe during the course of any scuba diving or travel program.

I, the applicant, or the parent or guardian of the minor applicant, declare that I / we have read and understand the contents hereof and that I / we hereby voluntarily sign this document.  No oral or other representations, statements or inducements have been made apart from this application and general release, assumption of risk, waiver of liability and indemnity agreement.

I, the applicant, or the parent or guardian of the minor applicant, in executing this document shall be deemed to have executed it for myself, as applicant, or parent or guardian of the minor applicant, all of my / their personal representatives, executors, successors, administrators, assigns, heirs and next of kin. I further acknowledge receipt of a copy of this document.

Date: November 22, 2019

Please select who will be participating in this adventure...
AdultMinor
Continue
First Guest's Name

First Name*

Middle Name

Last Name*

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

Height: *

Weight: *

Nationality: *

Passport Number: *

Place of Issue: *

Date of Issue: *

Date of Expiration: *

***We will often ask for a copy of your passport in order to ensure spelling and information for the issue of travel documents***

Will you be scuba diving on this trip?*

Date of your last scuba dive:

Location:

Level of Certification / List Specialties:

Certification Agency:

Dive Certifications Identification Number(s) / Agency Association(s):

Dive Insurance Association:

Membership #:

Expires:
Do you have any allergies?*

If YES:
Do you have any dietary restrictions?*

If YES:

Personal Physician:

Phone:

List any medical conditions, ailments, medical history or impairment that may or would make scuba diving or other high adventure activities more dangerous or expose you to exceptional risk:
If you listed anything above relating to your medical history and potential ailments or concerns, are you prepared to assume all liability for diving with such condition, ailment or impairment*

INSURANCE INFORMATION: 

There is always a need for both DIVE INSURANCE as well as some type of TRIP CANCELLATION / INTERRUPTION INSURANCE, in case of an emergency, while on your trip. The levels of coverage recommended do vary based on each individual's needs. This is something that we are happy to help you with, in order to give you the appropriate protections throughout your adventure. Additionally, we do have specific recommendations of both dive and cancellation / interruption insurance companies for you to use, based on their past history of effectively dealing with claims, levels of coverage and associated costs and also other factors like customer service and response time to inquiries, etc.

I WOULD LIKE ASSISTANCE REGARDING DIVE AND / OR TRAVEL INSURANCE:
First Guest's Signature*
Guest'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:*
Parent or Guardian's Email Address

Email*

Confirm Email*
Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone Number*
Trip Information

Destination: *

Dates of Trip:

to



Frequent Traveler Information:

Air Carrier Seating & Meal Preference (will be requested, cannot be guaranteed):
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*

Middle Name

Last Name*

Relationship*

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

Height: *

Weight: *

Nationality: *

Passport Number: *

Place of Issue: *

Date of Issue: *

Date of Expiration: *

***We will often ask for a copy of your passport in order to ensure spelling and information for the issue of travel documents***

Will you be scuba diving on this trip?*

Date of your last scuba dive:

Location:

Level of Certification / List Specialties:

Certification Agency:

Dive Certifications Identification Number(s) / Agency Association(s):

Dive Insurance Association:

Membership #:

Expires:
Do you have any allergies?*

If YES:
Do you have any dietary restrictions?*

If YES:

Personal Physician:

Phone:

List any medical conditions, ailments, medical history or impairment that may or would make scuba diving or other high adventure activities more dangerous or expose you to exceptional risk:
If you listed anything above relating to your medical history and potential ailments or concerns, are you prepared to assume all liability for diving with such condition, ailment or impairment*

INSURANCE INFORMATION: 

There is always a need for both DIVE INSURANCE as well as some type of TRIP CANCELLATION / INTERRUPTION INSURANCE, in case of an emergency, while on your trip. The levels of coverage recommended do vary based on each individual's needs. This is something that we are happy to help you with, in order to give you the appropriate protections throughout your adventure. Additionally, we do have specific recommendations of both dive and cancellation / interruption insurance companies for you to use, based on their past history of effectively dealing with claims, levels of coverage and associated costs and also other factors like customer service and response time to inquiries, etc.

I WOULD LIKE ASSISTANCE REGARDING DIVE AND / OR TRAVEL INSURANCE:
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