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Required for all certification courses.

THE DIVING COURSE YOU ARE ABOUT TO BEGIN IS AN EXCITING AND DEMANDING CHALLENGE!!

This diving course upon completion, will allow you to eventually explore the other three - fourths of our planet that is underwater. To accept the call of this underwater adventure you must be aware of the risks involved in the sport and to study and practice to achieve success.

This course will require heavy physical exertion. You will need to be able to equalize pressure in your ears and sinuses. Your respiratory and circulatory system must be in good health. You will need to complete a medical history form and your instructor may require you to be examined by a physician. You will need to read and sign this Statement of Understanding. If you are a minor you will need to have this form and the medical form signed by a parent or guardian.

Skin and Scuba diving are equipment-oriented sports. Some equipment is personal and may need to be purchased.

Other equipment can be rented or will be provided during the course, do not purchase equipment until it has been discussed in class and you know how to evaluate your purchases.  

The cost of an Intro to Scuba or Discovery Scuba Dive is $104.95 for a one-tank dive and $154.95 for a two-tank dive (No certification card issued for these dives). The cost of the open water course is $189 (up to 8 students) $280 (up to 4 students) $480 (up to 2 students) and $550 (private one person) this includes all scuba equipment for ocean dives unless arranged otherwise. The cost of the certification card is $39, if you qualify as an open water diver. Certification cards may be withheld until payment has been received by dive shop from activity center you paid your monies to.

Customer(s) wishing to cancel or reschedule activity must provide 72 hours notice to Maui Diving Scuba & Snorkel Center. Skipping days in class unless scheduled by the Dive Center will result in additional charges to you the participant (diver) should you choose to complete the dive class. This would be treated as a private course and the additional charges will reflect such.

All students not following class structure will be charged the single dive rate of $89.95 each dive (no exceptions). NO REFUNDS WILL BE GIVEN FOR CANCELLATIONS BY CUSTOMER WITH LESS THAN 72 HOURS NOTICE OR WHEN ALTERNATE SITES ARE SELECTED OR FOR ANY OTHER REASON, SUCH AS WEATHER, EAR TROUBLE, ILLNESS OR SEASICKNESS; BEFORE, DURING OR AFTER DIVING! Customer has been informed a medical form will follow. Failure of completion for reasons on the medical form within 72 hours does not constitute a refund.

BY INITIALING THIS PARAGRAPH I UNDERSTAND ALL OF THE ABOVE CONTENTS.  

Important information is included in every open water session. Because diving is built from a few basic steps to more complex concepts, you must attend every session of your training or your training will be incomplete. You will be required to make up any missed sessions at an additional cost to you. Bring paper and pencil to take notes in class and to fill out your logbook after dives. Your logbook and notes will help you study for the test evaluations. You will need to successfully complete a final classroom test and water evaluation in order to be certified.

I understand this is a home study course and performance based. Students will meet at the dive shop each morning unless instructor requests another location.

Open water sessions will be part of your normal open water training. There will be four open water dives to complete your course, which are required for certification. To help you study and become familiar with the terminology of the sport to gain an understand the concepts and laws that govern skin and scuba diving, you will need to have the course textbook. All of our instructors are affiliated with, and your text or eLearning will be with P.A.D.I.

(THE eLeaning OR COURSE STUDY BOOK AND LOG CAN BE PURCHASED AT THE DIVE SHOP. ONE OR THE OTHER ARE REQUIRED FOR CERTIFICATION.)

I understand that in undertaking dive training I am incurring obligations for attendance, skill performance and financial responsibility.  I understand that diving is a demanding and exciting sport that requires a commitment of time, money, cooperation and practice in order to become certified. I am willing to accept the risks and responsibilities for my own actions and I understand that the instructor must make the final judgment as to my competency.

I understand and agree that any equipment provided to me by the above listed individuals/agencies is to be returned upon my completion of class EACH DAY. Any equipment, which is provided to me and becomes lost or damaged throughout the course, will be paid by student, at full retail replacement cost. Kama'aina students have up to 3 months to complete dives and test.   The Instructor may change this time frame. Failure to complete the course within this time period, will result in the need to pay for another course and must be taken over. By signing this Cost and Statement of Understanding, I understand that I have purchased activity or service. I understand this contract supersedes all previous contracts and agreements with my credit card company and I personally guarantee payment in cash, or credit card to vendor MAUI DIVING - SCUBA & SNORKEL CENTER (LLC) Activity Centers known or unknown vendors ETC.

Please read carefully, fill in all blanks and agree to each paragraph before signing. I hereby affirm that I have been advised and thoroughly informed of the inherent hazards of skin and scuba diving.

I Agree

I further understand that diving with compressed air involves certain inherent risks: decompression sickness embolism, or other hyper baric injuries that can require treatment in a recompression chamber. I further understand that the open water diving trips, which are necessary for training and for scuba certification, may be conducted at a site that is remote, either by time/distance, from a recompression chamber. I still choose to proceed with such instructional dives in spite of the possible absence of a recompression chamber in proximity to the dive site.

I Agree

I further agree that under no circumstance will I make, prosecute or present any claim against those entities identified above for any act, omission or due to their negligence either passive or active relating to such activities or from the ownership, maintenance, use operation or control of any automobile, shop, boat, hotel, vehicle common carrier, or otherwise. It is my intention by signing this document to exempt and release those entities identified above and their agents servants contractors and employees from liability for personal injury, property damage wrongful death and loss of services whether caused by negligence either passive or active or other wise. By signing this document, I acknowledge that I assume all risk of personal injury, property damage, wrongful death or loss of services upon myself.

I Agree

In consideration of being allowed to enroll in this course, I hereby personally assume all risks in connection with said course for any harm, injury or damage that may befall me while I am enrolled as a student of this course including all risks connected therewith whether  foreseen  or  unforeseen.

I Agree

I further save and hold harmless said course and released all parties from any claim or lawsuit by family, my estate heirs, assignees, or me arising out of my enrollment and participation in this course, including both claims arising during the course or after I receive my scuba certification.

I Agree

I also understand that skin diving and scuba diving are physically strenuous activities and that I will be exerting myself during this diving course, and that if I am injured as a result of a heart attack, panic, hyperventilation, etc., that I will not hold the above listed individuals or companies responsible for the same.

I Agree

I further state that I am of lawful age and legally competent to sign this liability and release, or that I have acquired the written consent of my parent or legal guardian.

I Agree

I further state; I will not fly in an airplane or go to Haleakala Crater (volcano 10, 023ft.)  within 12 or 18 hours after my last dive or exceed 1,000 feet in elevation during this scuba diving class. I understand that drinking alcohol directly after diving may cause decompression sickness.

I Agree

I understand that the terms herein are contractual and not a mere recital, and that I have signed this document of my own free act.  I also understand by not initialing or signing any part of this liability and assumption of risk will be construed as I am doing so with full intent and knowledge to defraud these contract(s) and can be held responsible for fraud or terminated from this diving program at any time with no refund.

I Agree

I, by this instrument do exempt and release my instructor(s), the facility through which I received my instruction, Maui Diving- Scuba & Snorkel Center, PADI and ALL RELATED ENTITIES AS DEFINED OR UNDEFINED, from all liability or responsibility whatsoever for personal injury, property damage or wrongful death however caused. Including but not limited to negligence, whether passive or active and shall include released parties. I have fully informed myself of the contents of this liability release and express assumption of risk by reading it before I signed it on behalf of my heirs and myself. I further acknowledge I will be financially responsible with respect to payment for services rendered by entities. Maui Diving- Scuba & Snorkel Center all activity centers unknown but inclusive of payment. I personally guarantee payment by credit card, check, travelers check for activity regardless of locations, weather, ear trouble, seasickness or any other factors, which might arise before during or after diving.  By signing this release.  I have purchased activity or service and understand no refunds will be considered whatsoever. I understand this contract supersedes any and all previous agreements I have with my credit card company.

I Agree

First Participant's Name

First Name*

Middle Name

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Signature*
Second Participant's Name

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

Email*

Confirm Email*
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PADI Medical Questionnaire

To the Participant:

The purpose of this Medical Questionnaire is to find out if you should be examined by your doctor before participating in recreational diver training. A positive response to a question does not necessarily disqualify you from diving. A positive response means that there is a preexisting condition that may affect your safety while diving and you must seek the advice of your physician priorto engaging in dive activities.

This is a statement in which you are informed of some potential risks involved in scuba diving and of the conduct required of you during the scuba training program. Your signature on this statement is required for you to participate in the scuba training program offered by Maui Diving - Scuba & Snorkel Center located in the city of Lahaina, state of Hawaii.

Read this statement prior to signing it. You must complete this Medical Statement, which includes the medical questionnaire section, to enroll in the scuba training program. If you are a minor, you must have this Statement signed by a parent or guardian.

Diving is an exciting and demanding activity. When performed correctly, applying correct techniques, it is relatively safe. When established safety procedures are not followed, however, there are increased risks. To scuba dive safely, you should not be extremely overweight or out of condition. Diving can be strenuous under certain conditions. Your respiratory and circulatory systems must be in good health. All body air spaces must be normal and healthy. A person with coronary disease, a current cold or congestion, epilepsy, a severe medical problem or who is under the influence of alcohol or drugs should not dive. If you have asthma, heart disease, other chronic medical conditions or you are taking medications on a regular basis, you should consult your doctor and the instructor before participating in this program, and on a regular basis thereafter upon completion. You will also learn from the instructor the important safety rules regarding breathing and equalization while scuba diving. Improper use of scuba equipment can result in serious injury. You must be thoroughly instructed in its use under direct supervision of a qualified instructor to use it safely.

Please answer the following questions on your past or present medical history with a YES or NO. If you are not sure, answer YES. If any of these items apply to you, we must request that you consult with a physician prior to participating in scuba diving.You can download the PADI medical form online and page two will supply you with an RSTC Medical Statement and Guidelines for Recreational Scuba Diver's Physical Examination to take to your physician.

Could you be pregnant, or are you attempting to become pregnant?*
No
Yes
Are you presently taking prescription medications? (with the exception of birth control or anti-malarial)*
No
Yes
Are you over 45 years of age and can answer YES to one or more of the following? • currently smoke a pipe, cigars or cigarettes • have a high cholesterol level • have a family history of heart attack or stroke • are currently receiving medical care • high blood pressure • diabetes mellitus, even if controlled by diet alone*
No
Yes
Asthma, or wheezing with breathing, or wheezing with exercise?*
No
Yes
Frequent or severe attacks of hayfever or allergy, frequent colds, sinusitis or bronchitis??*
No
Yes
Any form of lung disease? Pneumothorax (collapsed lung)?*
No
Yes
Other chest disease or chest surgery?*
No
Yes
Behavioral health, mental or psychological problems (Panic attack, fear of closed or open spaces)?*
No
Yes
Blackouts or fainting (full/partial loss of consciousness)?*
No
Yes
Epilepsy, seizures, convulsions or take medications to prevent them?*
No
Yes
Recurring complicated migraine headaches or take medications to pre- vent them?*
No
Yes
Frequent or severe suffering from motion sickness (seasick, carsick, etc.)?*
No
Yes
Dysentery or dehydration requiring medical intervention?*
No
Yes
Any dive accidents or decompression sickness?*
No
Yes
Inability to perform moderate exercise (example: walk 1.6 km/one mile within 12 mins.)?*
No
Yes
Head injury with loss of consciousness in the past five years?*
No
Yes
Recurrent back problems? Back or spinal surgery?*
No
Yes
Diabetes?*
No
Yes
Back, arm or leg problems following surgery, injury or fracture?*
No
Yes
High blood pressure or take medicine to control blood pressure?*
No
Yes
Heart disease? Heart Attack? Angina, heart surgery or blood vessel surgery?*
No
Yes
Sinus surgery?*
No
Yes
Recurrent ear problems? Ear disease or surgery, hearing loss or problems with balance?*
No
Yes
Bleeding or other blood disorders?*
No
Yes
Hernia?*
No
Yes
Ulcers or ulcer surgery? A colostomy or ileostomy?*
No
Yes
Recreational drug use or treatment for, or alcoholism in the past five years?*
No
Yes

The information I have provided about my medical history is accurate to the best of my knowledge. I agree to accept responsibility for omissions regarding my failure to disclose any existing or past health condition.

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*

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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