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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 should be able to swim in the open ocean. 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 $119 for a one-tank dive and $169 for a two-tank dive (No certification card issued for these dives). The cost of the open water course is $239 (up to 8 students) $329 (up to 4 students) $529 (up to 2 students) and $599 (private one person) this includes all scuba equipment for ocean dives unless arranged otherwise. The cost of the certification card is $43.50, 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

I understand and agree that PADI Members (“Members”), including Maui Diving- Scuba & Snorkel Center and/or any individual PADI Instructors and Divemasters associated with the program in which I am participating, are licensed to use various PADI Trademarks and to conduct PADI training, but are not agents, employees or franchisees of PADI Americas, Inc, or its parent, subsidiary and affiliated corporations (“PADI”). I further understand that Member business activities are independent, and are neither owned nor operated by PADI, and that while PADI establishes the standards for PADI diver training programs, it is not responsible for, nor does it have the right to control, the operation of the Members’ business activities and the day-to-day conduct of PADI programs and supervision of divers by the Members or their associated staff. I further understand and agree on behalf of myself, my heirs and my estate that in the event of an injury or death during this activity, neither I nor my estate shall seek to hold PADI liable for the actions, inactions or negligence of Maui Diving - Scuba & Snorkel Center and/or the instructors and divemasters associated with the activity.

I HAVE FULLY INFORMED MYSELF AND MY HEIRS OF THE CONTENTS OF THIS NON-AGENCY DISCLOSURE AND ACKNOWLEDGMENT AGREEMENT BY READING IT BEFORE I SIGNED IT ON BEHALF OF MYSELF AND MY HEIRS.

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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Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone Number*
2020 PADI Diver Medical Participant 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 prior to 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. The physician providing medical clearance cannot be the student.

Recreational scuba diving and freediving requires good physical and mental health. There are a few medical conditions which can be hazardous while diving, listed below. Those who have, or are predisposed to, any of these conditions, should be evaluated by a physician. This Diver Medical Participant Questionnaire provides a basis to determine if you should seek out that evaluation. If you have any concerns about your diving fitness not represented on this form, consult with your physician before diving. If you are feeling ill, avoid diving. If you think you may have a contagious disease, protect yourself and others by not participating in dive training and/or dive activities. References to "diving" on this form encompass both recreational scuba diving and freediving. This form is principally designed as an initial medical screen for new divers, but is also appropriate for divers taking continuing education. For your safety, and that of others who may dive with you, answer all questions honestly. 

Note to Women: If you are pregnant, or attempting to become pregnant DO NOT DIVE.

Please answer these 10 questions. If you have to answer YES to one of them, please scroll down to the additional questions in the appropriately labeled section.
1. I have had problems with my lungs/breathing, heart, blood, or have been diagnosed with COVID-19. *
Yes (Go to Box A)
No
2. I am over 45 years of age. *
Yes (Go to Box B)
No
3. I struggle to perform moderate exercise (for example, walk 1.6 kilometer/one mile in 14 minutes or swim 200 meters/yards without resting), OR I have been unable to participate in a normal physical activity due to fitness or health reasons within the past 12 months. *
Yes*
No
4. I have had problems with my eyes, ears, or nasal passages/sinuses. *
Yes (Go to Box C)
No
5. I have had surgery within the last 12 months, OR I have ongoing problems related to past surgery. *
Yes*
No
6. I have lost consciousness, had migraine headaches, seizures, stroke, significant head injury, or suffer from persistent neurologic injury or disease. *
Yes (Go to Box D)
No
7. I am currently undergoing treatment (or have required treatment within the last five years) for psychological problems, personality disorder, panic attacks, or an addiction to drugs or alcohol; or, I have been diagnosed with a learning disability. *
Yes (Go to Box E)
No
8. I have had back problems, hernia, ulcers, or diabetes. *
Yes (Go to Box F)
No
9. I have had stomach or intestine problems, including recent diarrhea. *
Yes (Go to Box G)
No
10. I am taking prescription medications (with the exception of birth control or anti-malarial drugs other than mefloquine/Lariam). *
Yes*
No

If you answered NO to all 10 questions above a medical evaluation is not required. 

Please read and agree to the participant statement below by signing and dating it.

Participant Statement: I have answered all questions honestly, and understand that I accept responsibility for any consequences resulting from any questions I may have answered inaccurately or for my failure to disclose any existing or past health conditions. 

* If you answered YES to questions 3, 5 or 10 above OR to any of the subsequent questions in the boxes below, please read and agree to the statement above by signing and dating it AND take all three pages of this form (Participant Questionnaire and the Physician's Evaluation Form) to your physician for a medical evaluation. Participation in a diving course requires your physician's approval. 



Today's Date *

By Entering Your Name here you are digitally signing that you understand the above Participant Statement *
Box A - I Have/Have had:

Only answer these questions if you've said yes to Question 1 above.

Chest surgery, heart surgery, heart valve surgery, stent placement, or a pneumothorax (collapsed lung).
Yes
No
Asthma, wheezing, severe allergies, hay fever or congested airways within the last 12 months that limits my physical activity/exercise.
Yes
No
A problem or illness involving my heart such as: angina, chest pain on exertion, heart failure, immersion pulmonary edema, heart attack or stroke, OR am taking medication for any heart condition.
Yes
No
Recurrent bronchitis and currently coughing within the past 12 months, OR have been diagnosed with emphysema.
Yes
No
A diagnosis of COVID-19.
Yes
No
Box B - I am over 45 years of age AND:

Only answer these questions if you said YES to Question 2 above.

I currently smoke or inhale nicotine by other means.
Yes
No
I have a high cholesterol level.
Yes
No
I have high blood pressure.
Yes
No
I have had a close blood relative die suddenly or of cardiac disease or stroke before the age of 50, OR have a family history of heart disease before age 50 (including abnormal heart rhythms, coronary artery disease or cardiomyopathy).
Yes
No
Box C - I have/have had:

Only answer these questions if you said YES to Question 4 above.

Sinus surgery within the last 6 months.
Yes
No
Ear disease or ear surgery, hearing loss, or problems with balance.
Yes
No
Recurrent sinusitis within the past 12 months.
Yes
No
Eye surgery within the past 3 months.
Yes
No
Box D - I have/have had:

Only answer these questions if you said YES to Question 6 above.

Head injury with loss of consciousness within the past 5 years.
Yes
No
Persistent neurologic injury or disease.
Yes
No
Recurring migraine headaches within the past 12 months, or take medications to prevent them.
Yes
No
Blackouts or fainting (full/partial loss of consciousness) within the last 5 years.
Yes
No
Epilepsy, seizures, or convulsions, OR take medications to prevent them.
Yes
No
Box E - I have/have had:

Only answer these questions if you said YES to Question 7.

Behavioral health, mental or psychological problems requiring medical/psychiatric treatment.
Yes
No
Major depression, suicidal ideation, panic attacks, uncontrolled bipolar disorder requiring medication/psychiatric treatment.
Yes
No
Been diagnosed with a mental health condition or a learning/developmental disorder that requires ongoing care.
Yes
No
An addiction to drugs or alcohol requiring treatment within the last 5 years.
Yes
No
Box F - I have/have had:

Only answer these questions if you said YES to Question 8.

Recurrent back problems in the last 6 months that limit my everyday activity.
Yes
No
Back or spinal surgery within the last 12 months.
Yes
No
Diabetes, either insulin- or diet-controlled, OR gestational diabetes within the last 12 months.
Yes
No
An uncorrected hernia that limits my physical abilities.
Yes
No
Active or untreated ulcers, problem wounds, or ulcer surgery within the last 6 months.
Yes
No
Box G - I have had:

Only answer these questions if you said YES to Question 9.

Ostomy surgery and do not have medical clearance to swim or engage in physical activity.
Yes
No
Dehydration requiring medical intervention within the last 7 days.
Yes
No
Active or untreated stomach or intestinal ulcers or ulcer surgery within the last 6 months.
Yes
No
Frequent heartburn, regurgitation, or gastroesophageal reflux disease (GERD).
Yes
No
Active or uncontrolled ulcerative colitis or Crohn's disease.
Yes
No
Bariatric surgery within the last 12 months.
Yes
No
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. 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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