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Natural Springs Resort & Southern Ohio Diving Academy

Liability Release
For Certified Divers, Snorkelers & Supervised Students

This is a release of your rights to sue Natural Springs Resort & Southern Ohio Diving Academy (owners & dive supervisor), and it’s employees, instructors, certified assistants, dive training agencies or boat operators, 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/snorkeling as a result or negligence, not responsible for or held harmless for on-site camping. And/or out of the water slips and falls.

Please read and initial next to each of them.

1) I acknowledge that I am a certified scuba diver or am under the direction of a certified instructor trained in safe diving practices.

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

3) I affirm that I am in good mental and physical fitness for diving and that I am not under the influence of alcohol nor any drugs that are contradictory to diving. If I am taking medication I affirm that I have seen a physician and have been approved to dive while under the influence of the medication and/or drugs.

4) I am aware of the dangers of breath holding while scuba diving and I will not hold the above individuals responsible if I am injured doing so.

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

6) I will inspect all of my equipment (personal or rented) prior to the activity and will notify the above listed individuals if any of my equipment is not working properly. I will not hold the above listed individuals responsible for my failure to inspect the equipment (personal or rented etc.) prior to diving.

7) I acknowledge that I am physically fit to scuba dive/snorkel and I will not hold the above listed individuals responsible if I am injured as a result of heart, lung, ear or circulatory problems or other illnesses that occurred while diving and/or snorkeling.

8) I understand that even though I follow all the APPROPRIATE dive practices, there is still some risk of sustaining decompression sickness, embolism, or other hyperbolic injuries and I expressly assume the risks of these said injuries.

9) I also expressly assume the risk and accept responsibility to safely plan my dive and dive my plan.

10) I also understand that scuba diving/snorkeling is a physically strenuous activity and that I will be exerting myself during this diving excursion and then if I am injured as a result of a heart attack, panic, hyperventilation, etc. that I expressly assume the risk said injuries and that I will not hold the above listed individuals responsible for the same.

11) I also understand that on this open-water diving trip, I will 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.

12) IT IS THE INTENTION OF (DIVERS NAME), BY THIS INSTRUMENT TO EXEMPT AND RELEASE NATURAL SPRINGS RESORT & SOUTHERN OHIO DIVING ACADEMY. (Operator & Dive Supervisor) and (Dive Supervisors and/or Instructor,) AND ALL RELATED ENTITIES AS DEFINED ABOVE FROM ALL LIABILITY WHATSOEVER FOR PERSONAL INJURY, SLIPS & FALLS (in or out of the water), CAMPING, PROPERTY DAMAGE OR WRONGFUL DEATH CAUSED BY NEGLIGENCE.

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

<<< PLEASE PLACE YOUR INITIALS NEXT TO EACH OF THE FOLLOWING>>>

KNOW/UNKNOWN HAZARDS ABOVE AND BELOW THE WATER:

Overhangs, loose rocks, crevices, landscape and water environment, Iron scrap in or on the bottom of the quarry, Boats, cars, trees, etc. And other debris. 

Zealous fish, encountered when feeding fish 

Any and all unforeseen objects, known or unknown 

Rules:

NO DECOMPRESSION DIVING 

NO ALCOHOL 

NO TANK FILLING – AIR COMPRESSORS 

NO UNLEASHED PETS 

SWIMMING ALLOWED ONLY I, THE MARKED SWIMMING AREA 

NO SCUBA DIVING I, THE MARKED SWIMMING AREA 

NO ARTIFACTS, PROPERTY, OR UNDERWATER STRUCTURES MAY BE CHIPPED, DAMAGED OR REMOVED FROM THIS  SITE. 

NO SPEAR GUNS OR OTHER WEAPONS 

MANDATORY FLOTATIO, DEVICE (for ANYONE entering the water outside the swimming area) 

NO UNATTENDED CHILDREN 

I HAVE REVIEWED AND UNDERSTAND THIS RELEASE FORM

                                    

          I understand that diving with compressed air involves certain risks and injuries can occurs which require treatment in a recompression chamber.

          I further understand that the open water diving trips, which are necessary for training and certification may be conducted at a site that is remote. Either by time or distance or both, from such a recompression chamber, and I nonetheless agree to proceed with such instructional dives.

            I hereby personally assume all risk in connection with said course for any harm, injury or damage, which may befall me as a result of my participation in the course, whether foreseen or unforeseen, and I still wish to proceed with the course in spite of the possible absence or a recompression chamber of proximity to the dive site.

            I, either being a certified diver or under instruction with a known certifying agency have read and fully understand this release prior to signing it.

Today's Date: December 15, 2018

First Participant's Name

First Name*

Last Name*

Phone*
First Participant's Date of Birth*
I certify that I am 18 years of age or older
First Participant's Information

Dive Buddy

Scuba Certification *

Level *

Card # *

Instructor

Instructor #
First Participant's Signature*
Second Participant's Name

First Name*

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

Dive Buddy

Scuba Certification *

Level *

Card # *

Instructor

Instructor #
Third Participant's Name

First Name*

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

Dive Buddy

Scuba Certification *

Level *

Card # *

Instructor

Instructor #
Fourth Participant's Name

First Name*

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

Dive Buddy

Scuba Certification *

Level *

Card # *

Instructor

Instructor #
Fifth Participant's Name

First Name*

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

Dive Buddy

Scuba Certification *

Level *

Card # *

Instructor

Instructor #
Sixth Participant's Name

First Name*

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

Dive Buddy

Scuba Certification *

Level *

Card # *

Instructor

Instructor #
Seventh Participant's Name

First Name*

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

Dive Buddy

Scuba Certification *

Level *

Card # *

Instructor

Instructor #
Eighth Participant's Name

First Name*

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

Dive Buddy

Scuba Certification *

Level *

Card # *

Instructor

Instructor #
Ninth Participant's Name

First Name*

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

Dive Buddy

Scuba Certification *

Level *

Card # *

Instructor

Instructor #
Tenth Participant's Name

First Name*

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

Dive Buddy

Scuba Certification *

Level *

Card # *

Instructor

Instructor #
Participant'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*
Check to receive information, news, and discounts by e-mail.
Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone Number*
As a parent or guardian, I am signing this document on behalf of a minor child. I am aware of the legal consequences of signing this agreement, and do hereby agree to be specifically bound to all the terms and conditions of this agreement on behalf of the minor child.
Parent or Guardian's Name

First Name*

Last Name*

Phone*
Parent or Guardian's Date of Birth*
I certify that I am 18 years of age or older
Parent or Guardian's Information

Dive Buddy

Scuba Certification *

Level *

Card # *

Instructor

Instructor #
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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