Scuba Waiver

Pacific Star Charters

141 W. 22nd St.

San Pedro, Calif.

626-818-9684

Co~~This WAIVER and RELEASE ("Release") is entered into and as of the last date set forth below by and
between Pacific Star Charters ("Company") and ("Customer"). Company operates a recreational fishing and diving vessel ("Vessel"), and Customer desires to pay Company or chartering agency to transport Customer on the Vessel that Customer may engage in recreational fishing or diving ("Charter"), It is now the desire of the parties that Customer hire Company or chartering agency for the Charter, but waive and release Company or chartering agency for any liability in connection therewith. In consideration of the payment of the Charter fees to Company or chartering agency , receipt of which is hereby acknowledged, and the releases, promises and covenants herein, the parties agree as follows:

1. Company and Customer or chartering agency hereby agree to the Charter, specifically described on the attached Exhibit.

2. Customer does hereby acknowledge that the sports of recreational fishing and diving are potentially dangerous, and Customer represents and warrants to Company that Customer is an experienced and, if applicable, certified participant in the sport in which he will be engaged on the Charter, knows the risks and hazards thereof, does not look to the Company for any guidance or protection in connection therewith, and assumes all risks associated therewith. Customer therefore waives any rights or claims he may have now or in the future against Company or chartering agency in connection with said Charter, and does hereby release, hold harmless, and absolutely and forever discharge Company or chartering agency from all claims, actions and causes of action which he has or may have against Company or chartering agency arising out of or in connection with the Charter.

3. It is the intention of the parties hereto by the executing of this Release, that the Release herein shall be effective as full and final releases of each and every released matter. In furtherance of these intentions. each party hereto acknowledges that he is familiar with Section 1542 of the Civil Code of the State of California which provides as follows: "A general release does not extend to claims which the creditor does not know or suspect to exist in his favor at the time of executing the release, which if known by him must have materially affected his settlement with the debtor." All parties hereto expressly waive and relinquish each and every right or benefits which he, she or it has or may have under Section 1542 of the Civil Code of the State of California. In connection with such waiver and relinquishment, each party hereto acknowledges that it is his, her or its intention hereby to fully, finally and forever settle and release all disputes and differences related to the released matters, known or unknown, suspected or unsuspected, and the General Release shall be and remain effective as full and complete general releases of released matters notwithstanding the discovery or existence of any such additional or different facts.

4. In the event of any dispute between Company or chartering agency and Customer concerning this Release or the subject matter hereof, or the failure of any consideration referenced herein, the prevailing party in such dispute shall be entitled to an award of its reasonable attorneys' fees and all costs incurred in connection therewith.

5. The handling of customers personnel gear by the boat crew, i.e. weights, BCD, camaras, DPVs or any other personnel property brought to boat by customer related to the act of diving or not shall be done only as a courtesy and shall bear no liability to either company or crew member. By the signing of this document customer accepts any and all liability for their property regardless of the occurrence.

Please select who will be participating...

Adult Minor(s)
1 Minor 2 Minors 3 Minors 4 Minors 5 Minors More Minors 6 Minors 7 Minors 8 Minors 9 Minors 10 Minors

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First Diver Name

First Name*

Last Name*

Phone*

First Diver Date of Birth*

First Diver Information

Certifying Agency(PADI, SSI, etc.)

Level of Certification(Student, Open Water, Advanced, etc.) *

Number of Logged Dives *

Date of Last Dive *

Date of Pacific Star Boat Trip *

Will you be taking fish or other game on this trip?*

Yes

I confirm that I have not tested positive for nor have any symptoms associated with COVID-19. I confirm that I have not had any contact with any persons who have tested positive for or had any symptoms associated with COVID-19. If I begin to show symptoms associated with COVID-19 before or on the date of the trip aboard the Pacific Star I will not board the vessel and instead shall remain home.*

No. I have not tested positive for Covid nor have I been in close proximity to known person(s) who are positive.

Yes. I am positive or have been in close proximity to known Covid positive person(s)

First Diver Signature*

Type Signature

Draw Signature

Click to Sign

Second Diver Name

First Name*

Last Name*

Second Diver Date of Birth*

Second Diver Information

Certifying Agency(PADI, SSI, etc.)

Level of Certification(Student, Open Water, Advanced, etc.) *

Number of Logged Dives *

Date of Last Dive *

Date of Pacific Star Boat Trip *

Will you be taking fish or other game on this trip?*

Yes

No. I have not tested positive for Covid nor have I been in close proximity to known person(s) who are positive.

Yes. I am positive or have been in close proximity to known Covid positive person(s)

Third Diver Name

First Name*

Last Name*

Third Diver Date of Birth*

Third Diver Information

Certifying Agency(PADI, SSI, etc.)

Level of Certification(Student, Open Water, Advanced, etc.) *

Number of Logged Dives *

Date of Last Dive *

Date of Pacific Star Boat Trip *

Will you be taking fish or other game on this trip?*

Yes

No. I have not tested positive for Covid nor have I been in close proximity to known person(s) who are positive.

Yes. I am positive or have been in close proximity to known Covid positive person(s)

Fourth Diver Name

First Name*

Last Name*

Fourth Diver Date of Birth*

Fourth Diver Information

Certifying Agency(PADI, SSI, etc.)

Level of Certification(Student, Open Water, Advanced, etc.) *

Number of Logged Dives *

Date of Last Dive *

Date of Pacific Star Boat Trip *

Will you be taking fish or other game on this trip?*

Yes

No. I have not tested positive for Covid nor have I been in close proximity to known person(s) who are positive.

Yes. I am positive or have been in close proximity to known Covid positive person(s)

Fifth Diver Name

First Name*

Last Name*

Fifth Diver Date of Birth*

Fifth Diver Information

Certifying Agency(PADI, SSI, etc.)

Level of Certification(Student, Open Water, Advanced, etc.) *

Number of Logged Dives *

Date of Last Dive *

Date of Pacific Star Boat Trip *

Will you be taking fish or other game on this trip?*

Yes

No. I have not tested positive for Covid nor have I been in close proximity to known person(s) who are positive.

Yes. I am positive or have been in close proximity to known Covid positive person(s)

Sixth Diver Name

First Name*

Last Name*

Sixth Diver Date of Birth*

Sixth Diver Information

Certifying Agency(PADI, SSI, etc.)

Level of Certification(Student, Open Water, Advanced, etc.) *

Number of Logged Dives *

Date of Last Dive *

Date of Pacific Star Boat Trip *

Will you be taking fish or other game on this trip?*

Yes

No. I have not tested positive for Covid nor have I been in close proximity to known person(s) who are positive.

Yes. I am positive or have been in close proximity to known Covid positive person(s)

Seventh Diver Name

First Name*

Last Name*

Seventh Diver Date of Birth*

Seventh Diver Information

Certifying Agency(PADI, SSI, etc.)

Level of Certification(Student, Open Water, Advanced, etc.) *

Number of Logged Dives *

Date of Last Dive *

Date of Pacific Star Boat Trip *

Will you be taking fish or other game on this trip?*

Yes

No. I have not tested positive for Covid nor have I been in close proximity to known person(s) who are positive.

Yes. I am positive or have been in close proximity to known Covid positive person(s)

Eighth Diver Name

First Name*

Last Name*

Eighth Diver Date of Birth*

Eighth Diver Information

Certifying Agency(PADI, SSI, etc.)

Level of Certification(Student, Open Water, Advanced, etc.) *

Number of Logged Dives *

Date of Last Dive *

Date of Pacific Star Boat Trip *

Will you be taking fish or other game on this trip?*

Yes

No. I have not tested positive for Covid nor have I been in close proximity to known person(s) who are positive.

Yes. I am positive or have been in close proximity to known Covid positive person(s)

Ninth Diver Name

First Name*

Last Name*

Ninth Diver Date of Birth*

Ninth Diver Information

Certifying Agency(PADI, SSI, etc.)

Level of Certification(Student, Open Water, Advanced, etc.) *

Number of Logged Dives *

Date of Last Dive *

Date of Pacific Star Boat Trip *

Will you be taking fish or other game on this trip?*

Yes

No. I have not tested positive for Covid nor have I been in close proximity to known person(s) who are positive.

Yes. I am positive or have been in close proximity to known Covid positive person(s)

Tenth Diver Name

First Name*

Last Name*

Tenth Diver Date of Birth*

Tenth Diver Information

Certifying Agency(PADI, SSI, etc.)

Level of Certification(Student, Open Water, Advanced, etc.) *

Number of Logged Dives *

Date of Last Dive *

Date of Pacific Star Boat Trip *

Will you be taking fish or other game on this trip?*

Yes

No. I have not tested positive for Covid nor have I been in close proximity to known person(s) who are positive.

Yes. I am positive or have been in close proximity to known Covid positive person(s)

Diver 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*

Check to receive information, news, and discounts by e-mail.

Emergency Contact

First Name*

Last 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.

By signing below the parent or court-appointed legal guardian agrees that they are also 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

Certifying Agency(PADI, SSI, etc.)

Level of Certification(Student, Open Water, Advanced, etc.) *

Number of Logged Dives *

Date of Last Dive *

Date of Pacific Star Boat Trip *

Will you be taking fish or other game on this trip?*

Yes

No. I have not tested positive for Covid nor have I been in close proximity to known person(s) who are positive.

Yes. I am positive or have been in close proximity to known Covid positive person(s)

Parent or Guardian's Signature*

Type Signature

Draw Signature

Click to Sign

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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