Loading...

BOAT DIVING WAIVER

Statement of Understanding

  1. Warranty of Ability - I understand that each person who signs up for a dive trip with Sunshine Coast Diving Centre Pty Ltd (trading as Scuba World) warrants that he or she is physically and mentally capable of participating successfully in that activity.  I further understand and agree that Sunshine Coast Diving Centre Pty Ltd (trading as Scuba World) will give no refunds for seasickness, inability to equalize, cold, fatigued or for any other reason that prevents an individual from participating fully.
  2. I further understand that any underwater guide service provided by Sunshine Coast Diving Centre Pty Ltd (trading as Scuba World) is done solely to enhance my enjoyment and not because such guidance is required to compensate for lack of ability on my part. If I do not believe that I have maintained at least the same level of ability as a newly certified diver, I understand that I should take part in a refresher course before participating in any dive trip with Scuba World.
  3. Minors - I understand that a parent or guardian must sign all minors' forms.
  4. Possible changes - I understand that the scheduled dive destinations are subject to weather and conditions, and Scuba World reserves the right to cancel dive trips or change destinations at any time. I further understand that some dive trips may be cancelled at any time due to lack of sufficient participation.

LIABILITY RELEASE FOR SUPERVISION OF CERTIFIED DIVERS

This is a release of your rights to sue Sunshine Coast Diving Centre Pty Ltd trading as Scuba World and its employees, agents and assigns for personal injuries or wrongful death that may occur during the forthcoming dive activity as a result of the inherent risks associated with scuba diving or as a result of negligence.

IT IS MY INTENTION BY THIS INSTRUMENT TO EXEMPT AND RELEASE SUNSHINE COAST DIVING CENTRE PTY LTD TRADING AS SCUBA WORLD AND ALL RELATED ENTITIES AS DEFINED ABOVE FROM ALL LIABILITY WHATSOEVER FOR PERSONAL INJURY, PROPERTY DAMAGE,AND WRONGFUL DEATH CAUSED BY NEGLIGENCE.

I affirm that I am in good mental and physical fitness for diving.  I am not under the influence of alcohol, nor am I under the influence of drugs which are contradictory to diving. If I am taking prescriptive medication (other than the contraceptive pill), I affirm that I have seen a diving physician and have approval to dive while under the influence of the medication/ drugs.

I am aware that I will be diving with a buddy, and it will be our responsibility to plan a dive allowing for our limitations and the prevailing water conditions. I will not hold the above listed businesses and individuals responsible for my failure to safely plan my dive.

I will inspect all of my equipment prior to the activity and will notify the above listed businesses and /or individuals if any of my equipment is not working properly. I will not hold the above listed businesses nor individuals responsible for my failure to inspect my equipment prior to diving. 

I acknowledge that I am physically fit to scuba dive, and I will not hold the above listed businesses nor individuals responsible if I am injured while diving including but not limited to those as a result of heart, lung, ear, skeletal or circulatory problems or other illnesses. 

I also understand that scuba diving is a physically strenuous activity and that I will be exerting myself during this diving excursion, and that if I am injured as a result of a heart attack, panic, hyperventilation, aspirating water etc, that I expressly assume the risk of said injuries and that I will not hold the above listed businesses nor individuals responsible for the same.

I also understand that on this open water diving trip, I will be at a remote site and that there will not be immediate medical care or hyperbaric care available to me, and I expressly assume the risk of diving in such a remote spot. 

I understand that certain physical conditions are absolute contraindications to scuba diving. I affirm that I do not have any of the following conditions: Congestive heart condition, History of Seizures, active Asthma, Pregnancy, Insulin Dependent Diabetes, or history of ear problems. I am not extremely over weight or out of condition. My circulatory and respiratory systems are in good health and my body air spaces are normal. I will not hold Sunshine Coast Diving Centre Pty Ltd trading as Scuba World  nor any individuals responsible for my failure  to disclose these conditions. 

I acknowledge that I am a certified diver trained in safe diving practices.

I am aware of the risks inherent in this sport and accept these risks. 

I am aware of the dangers of breath holding while scuba diving, and will not hold Sunshine Coast Diving Centre Pty Ltd trading as Scuba World and related entities (such as employees, instructors, certified assistants, boat operators, or diver training agencies) responsible if I am injured doing so.

I understand that even though I follow all the appropriate dive practices, there is still some risk of my sustaining decompression sickness, embolism, or other baro-trauma, and I expressly assume the risk of such injuries. 

I also expressly assume the risk and accept the responsible to plan my dive and dive my plan. 

I HAVE FULLY INFORMED MYSELF OF THE CONTENTS OF THIS INFORMATION AND RELEASE BY READING IT BEFORE I SIGNED IT ON THE BEHALF OF MYSELF AND MY HEIRS.

I Agree
with the STATEMENT OF UNDERSTANDING and all items listed in the LIABILITY RELEASE FOR SUPERVISION OF CERTIFIED DIVERS.


Date: December 11, 2018

First Participant's Name

First Name*

Last Name*

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

Diving History

Are you a certified diver?*
Yes
No

Maximum depth dived:
Highest Qualification:*
Name of Certification Agency:*

OTHER:

Student / Certification Number (compulsory): *

Number of dives: *

Date of last dive (Month and Year only) *
Since completing your last dive medical assessment, have you suffered any illness or injury that may affect your ability to dive safely?*
Yes
No

If yes, please provide details:
Are you planning to fly in an aircraft within 24 hours of your last dive?*
Yes
No

Mandatory Items

The Queensland diving code of practice states that all divers MUST carry a safety sausage, whistle, and a dive computer. Do you own or will you be hiring all three of these items?*
First Participant's Signature*
Second Participant's Name

First Name*

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

Diving History

Are you a certified diver?*
Yes
No

Maximum depth dived:
Highest Qualification:*
Name of Certification Agency:*

OTHER:

Student / Certification Number (compulsory): *

Number of dives: *

Date of last dive (Month and Year only) *
Since completing your last dive medical assessment, have you suffered any illness or injury that may affect your ability to dive safely?*
Yes
No

If yes, please provide details:
Are you planning to fly in an aircraft within 24 hours of your last dive?*
Yes
No

Mandatory Items

The Queensland diving code of practice states that all divers MUST carry a safety sausage, whistle, and a dive computer. Do you own or will you be hiring all three of these items?*
Third Participant's Name

First Name*

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

Diving History

Are you a certified diver?*
Yes
No

Maximum depth dived:
Highest Qualification:*
Name of Certification Agency:*

OTHER:

Student / Certification Number (compulsory): *

Number of dives: *

Date of last dive (Month and Year only) *
Since completing your last dive medical assessment, have you suffered any illness or injury that may affect your ability to dive safely?*
Yes
No

If yes, please provide details:
Are you planning to fly in an aircraft within 24 hours of your last dive?*
Yes
No

Mandatory Items

The Queensland diving code of practice states that all divers MUST carry a safety sausage, whistle, and a dive computer. Do you own or will you be hiring all three of these items?*
Fourth Participant's Name

First Name*

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

Diving History

Are you a certified diver?*
Yes
No

Maximum depth dived:
Highest Qualification:*
Name of Certification Agency:*

OTHER:

Student / Certification Number (compulsory): *

Number of dives: *

Date of last dive (Month and Year only) *
Since completing your last dive medical assessment, have you suffered any illness or injury that may affect your ability to dive safely?*
Yes
No

If yes, please provide details:
Are you planning to fly in an aircraft within 24 hours of your last dive?*
Yes
No

Mandatory Items

The Queensland diving code of practice states that all divers MUST carry a safety sausage, whistle, and a dive computer. Do you own or will you be hiring all three of these items?*
Fifth Participant's Name

First Name*

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

Diving History

Are you a certified diver?*
Yes
No

Maximum depth dived:
Highest Qualification:*
Name of Certification Agency:*

OTHER:

Student / Certification Number (compulsory): *

Number of dives: *

Date of last dive (Month and Year only) *
Since completing your last dive medical assessment, have you suffered any illness or injury that may affect your ability to dive safely?*
Yes
No

If yes, please provide details:
Are you planning to fly in an aircraft within 24 hours of your last dive?*
Yes
No

Mandatory Items

The Queensland diving code of practice states that all divers MUST carry a safety sausage, whistle, and a dive computer. Do you own or will you be hiring all three of these items?*
Sixth Participant's Name

First Name*

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

Diving History

Are you a certified diver?*
Yes
No

Maximum depth dived:
Highest Qualification:*
Name of Certification Agency:*

OTHER:

Student / Certification Number (compulsory): *

Number of dives: *

Date of last dive (Month and Year only) *
Since completing your last dive medical assessment, have you suffered any illness or injury that may affect your ability to dive safely?*
Yes
No

If yes, please provide details:
Are you planning to fly in an aircraft within 24 hours of your last dive?*
Yes
No

Mandatory Items

The Queensland diving code of practice states that all divers MUST carry a safety sausage, whistle, and a dive computer. Do you own or will you be hiring all three of these items?*
Seventh Participant's Name

First Name*

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

Diving History

Are you a certified diver?*
Yes
No

Maximum depth dived:
Highest Qualification:*
Name of Certification Agency:*

OTHER:

Student / Certification Number (compulsory): *

Number of dives: *

Date of last dive (Month and Year only) *
Since completing your last dive medical assessment, have you suffered any illness or injury that may affect your ability to dive safely?*
Yes
No

If yes, please provide details:
Are you planning to fly in an aircraft within 24 hours of your last dive?*
Yes
No

Mandatory Items

The Queensland diving code of practice states that all divers MUST carry a safety sausage, whistle, and a dive computer. Do you own or will you be hiring all three of these items?*
Eighth Participant's Name

First Name*

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

Diving History

Are you a certified diver?*
Yes
No

Maximum depth dived:
Highest Qualification:*
Name of Certification Agency:*

OTHER:

Student / Certification Number (compulsory): *

Number of dives: *

Date of last dive (Month and Year only) *
Since completing your last dive medical assessment, have you suffered any illness or injury that may affect your ability to dive safely?*
Yes
No

If yes, please provide details:
Are you planning to fly in an aircraft within 24 hours of your last dive?*
Yes
No

Mandatory Items

The Queensland diving code of practice states that all divers MUST carry a safety sausage, whistle, and a dive computer. Do you own or will you be hiring all three of these items?*
Ninth Participant's Name

First Name*

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

Diving History

Are you a certified diver?*
Yes
No

Maximum depth dived:
Highest Qualification:*
Name of Certification Agency:*

OTHER:

Student / Certification Number (compulsory): *

Number of dives: *

Date of last dive (Month and Year only) *
Since completing your last dive medical assessment, have you suffered any illness or injury that may affect your ability to dive safely?*
Yes
No

If yes, please provide details:
Are you planning to fly in an aircraft within 24 hours of your last dive?*
Yes
No

Mandatory Items

The Queensland diving code of practice states that all divers MUST carry a safety sausage, whistle, and a dive computer. Do you own or will you be hiring all three of these items?*
Tenth Participant's Name

First Name*

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

Diving History

Are you a certified diver?*
Yes
No

Maximum depth dived:
Highest Qualification:*
Name of Certification Agency:*

OTHER:

Student / Certification Number (compulsory): *

Number of dives: *

Date of last dive (Month and Year only) *
Since completing your last dive medical assessment, have you suffered any illness or injury that may affect your ability to dive safely?*
Yes
No

If yes, please provide details:
Are you planning to fly in an aircraft within 24 hours of your last dive?*
Yes
No

Mandatory Items

The Queensland diving code of practice states that all divers MUST carry a safety sausage, whistle, and a dive computer. Do you own or will you be hiring all three of these items?*
Parent or Guardian's Email Address

Email*
A signed copy of this waiver will be sent to the email address you provide.
Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone Number*
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 Information

Diving History

Are you a certified diver?*
Yes
No

Maximum depth dived:
Highest Qualification:*
Name of Certification Agency:*

OTHER:

Student / Certification Number (compulsory): *

Number of dives: *

Date of last dive (Month and Year only) *
Since completing your last dive medical assessment, have you suffered any illness or injury that may affect your ability to dive safely?*
Yes
No

If yes, please provide details:
Are you planning to fly in an aircraft within 24 hours of your last dive?*
Yes
No

Mandatory Items

The Queensland diving code of practice states that all divers MUST carry a safety sausage, whistle, and a dive computer. Do you own or will you be hiring all three of these items?*
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