Pennyroyal Scuba respects all of our guests right to privacy. Pennyroyal Scuba will not release any information including contact information to any person at any time. We do not release or sell our guest infomation to any 3rd parties for any reason. Furthermore we respect our dive shops and instructors that use our park for training and will not email or solicit their students or divers. Only those who choose to be on our email list with be included. We do not sign anyone up to our email list. If a diver wants to receive emails from us, they must sign up themselves as it is against our policy to do it for them. 

!!!Your information is protected and will not be released!!!

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Diver Registration & Lifetime Liability Waiver


Review Pennyroyal Scuba Blue Springs Privacy Policy

Lifetime Release of Liability & Express Assumption of Risk

Please read the Statement & Understanding carefully. Fill in ALL blanks before signing

This is a release of your rights to sue Pennyroyal Scuba Blue Springs and its Owners, Staff, Agents and Assigns for personal injuries or wrongful death that may occur during the forthcoming dive activity as a result of the inherent risk associated with scuba diving/snorkeling or a result of negligence. This release will be used against you in the court of law if you or your heirs sue a released party or person.

 

I Agree
I Hereby state that I have taken a certified SCUBA course and have been issued a Scuba Certification Card, or am on this date taking part in a field trip dive under the supervision of a Certified Scuba Instructor.

 

I Agree
I further state that I understand that the risk inherent in the conduct of skin diving or scuba diving and that my welfare cannot be the responsibility of the management of the facility.

 

I Agree
I understand that the water in which I intend to enter here is of adequate depth (approx 30ft.) to expose me to medical and health risk and I hereby state that I am fully aware of such potential problems.

 

I Agree
I also understand that skin diving/scuba diving are physically strenuous activities and that I will be exerting myself during this activity, and that if I am injured as a result of a heart attack, panic, hyperventilation, or any other seen or unforeseen medical problems, that I expressly assume the risk of said injuries and that I will not hold the above listed individuals or companies responsible for the same.

 

I Agree
I understand that it is impossible for the management, staff, agents & assigns, of Pennyroyal Scuba Blue Springs to supervise and protect me while scuba diving and or skin diving due to the nature of the sport.

 

I Agree
I understand that diving with compressed air and following safe diving practices involves certain inherent risks, decompression sickness, embolism, or other hyperbaric injuries, and I expressly assume the risk of said injuries foreseen and/or unforeseen.

 

I Agree
 I also understand that is it my responsibility to secure my vehicle and my personal property, and that Pennyroyal Scuba Blue Springs is in no way responsible for the theft or damages to that vehicle, or any lost or stolen articles of mine. I have taken all steps necessary to acquaint myself with this facility, and the various underwater obstacles. I hereby agree fully assume all risks foreseen and unforeseen while on the premises or on, in, entering or leaving the water. I also understand that spear fishing, firearms, alcohol, pets, and personal air fill stations are strictly forbidden. I agree to abide by the warnings and restrictions printed thereon.

 

I Agree
 I further state that I am of lawful age and legally competent and not under the influence of alcohol or drugs to sign the liability and release, or that I have acquired the written consent of my parent or guardian.

 

I Agree
 I agree to abide by all rules set fourth by Pennyroyal Scuba Blue Springs, and that if I do not follow these rules that I will have to accept the consequences that I could face

 

I Agree
 I also understand that Pennyroyal Scuba Blue Springs Resort reserves the right to refuse service to anyone at any time for any reason, and that if asked to leave I understand that I forfeit the admission fee that I have paid

 

I Agree
 I understand that the terms herein are contractual and are not a mere recital and that I have signed this document of my own free will.

 

I Agree
 I furthermore understand that this contract shall remain a permanent record with the resort. I also understand that I will have to sign an acknowledgement & agreement statement of this release each time I arrive on the resort property.

 

Media Copyright Release

 

I Agree
I understand that I am allowed to take photos and video during my visit. I agree to release to Pennyroyal Scuba any copyright on any media (photos or videos) I take during my visit. I also understand that Pennyroyal Scuba may use my photos or video for marketing purposes and that I will not receive any compensation for their use of my photos or videos. To all this, I release any copyright claim on any photo/video that I take while on Pennyroyal Scuba Property to Pennyroyal Scuba for their use.This includes any underwater, surface or aerial images or video. 

Personal use of media recorded while at Pennyroyal Scuba is encouraged. However Pennyroyal Scuba reserves the right to limit use of park images for commercial use. Prior written consent must be obtained for media being used commercially of our park. If premission is granted, credit of the park must be given in the media. All media recorded on or over (aerial) the park property is considered intellectual property of Pennyroyal Scuba and may be denied or granted premission to use commercially. Personal use of media will not require approval and is free to post on personal platforms.

 

Today's Date: December 5, 2020

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First Divers Name

First Name*

Last Name*

Phone*
First Divers Date of Birth*
First Divers Information
Certifying Agency:*

Other Agency Not Listed
Are You A:*
Certification Level*
First Divers Signature*
Divers 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*
Parent or Guardian's Driver's License / ID Card

Driver's License / ID Card Number*

Issuing State*
As the parent or guardian, I am signing this document on behalf of my minor child and agree to be specifically bound to all the terms and conditions herein. I have read this agreement, fully and understand the terms herein, understand that I have given up substantial rights by signing it, am aware of its legal consequences, and have signed this document freely and voluntarily without any inducement, assurance, or guarantee having been made to me. I intend my signature to be a complete unconditional release of all liability, damages, or cost that may occur which arises out of my minor child’s scuba diving/or snorkeling, swimming, or any other activities on or about the premises of Pennyroyal Scuba Blue Springs, whether caused by negligence of Pennyroyal Scuba Blue Springs, or otherwise.
Parent or Guardian's Name

First Name*

Last Name*

Relationship*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Information
Certifying Agency:*

Other Agency Not Listed
Are You A:*
Certification Level*
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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