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PLEASE

READ COMPLETELY &

FILL IN THE BLANKS

 

 

If you are FLYING WITHIN 18 HOURS of this Tour,

PLEASE ADVISE A STAFF MEMBER before completing waiver

 

RELEASE OF LIABILITY, WAIVER OF CLAIMS, EXPRESS ASSUMPTION OF RISK AND INDEMNITY AGREEMENT

If you are FLYING WITHIN 18 HOURS of completion of this Tour,

PLEASE ADVISE A STAFF MEMBER before completing waiver

CERTIFIED DIVERS 

 

Today's Date: October 31, 2020

EXPRESS ASSUMPTION OF RISK ASSOCIATED WITH DIVING AND RELATED ACTIVITIES

 

Non-Agency Disclosure and Acknowledgment Agreement I understand and agree that PADI Members (“Members”), including Puerto Rico Diving< Inc. dba Rincon Diving & Snorkeling 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 Puerto Rico Diving, Inc. dba Rincon Diving & Snorkeling and/or the instructors and divemasters associated with the activity.

Liability Release and Assumption of Risk Agreement I hereby affirm that I am a certified scuba diver trained in safe dive practices and know that skin diving and scuba diving (hereinafter “Diving”) have inherent risks which may result in serious injury or death. I understand that scuba diving with compressed air involves certain inherent risks; including but not limited to decompression sickness, embolism or other hyperbaric/air expansion injury that require treatment in a recompression chamber. If I am scuba diving with oxygen enriched air (“Enriched Air”) or other gas blends including oxygen, I also understand that it involves inherent risks of oxygen toxicity and/or improper mixtures of breathing gas. I further understand that the Diving activities will be conducted at a site that is remote, either by time or distance or both, from such a recompression chamber. I still choose to proceed with these activities in spite of the absence of a recompression chamber in proximity to the dive site(s). I understand and agree that neither Puerto Rico Diving, Inc. dba Rincon Diving & Snorkeling, nor the dive professional(s) who may be present at the dive site, nor PADI Americas, Inc., nor its affiliate and subsidiary corporations, nor any of their respective employees, officers, agents, contractors and assigns (hereinafter “Released Parties”) may be held liable or responsible in any way for any injury, death or other damages to me, my family, estate, heirs or assigns that may occur during Diving activities as a result of my participation in Diving or as a result of the negligence of any party, including the Released Parties, whether passive or active. I affirm I am in good mental and physical fitness for Diving. I further state that I am not under the influence of alcohol or any drugs that are contraindicated to Diving. If I am taking mediation, I affirm that I have seen a physician and have approval to dive while under the influence of the medication/drugs. I understand that Diving is a physically strenuous activity and that I will be exerting myself during this activity and that if I am injured as a result of heart attack, panic, hyperventilation, drowning or any other cause, that I expressly assume the risk of said injuries and that I will not hold the Released Parties responsible for the same. I am aware that safe dive practices suggest diving with a buddy unless trained as a self-reliant diver. Accordingly, it is my responsibility to plan my dive allowing for my diving experience and limitations, and the prevailing water conditions and environment. I will not hold the Released Parties responsible for my failure to safely plan my dive, dive my plan, and follow the instructions and dive briefing of the dive professional(s). I affirm it is my responsibility to inspect all of my equipment prior to the Excursion and that I should not dive if my equipment is not functioning properly. I will not hold the Released Parties responsible for my failure to inspect my equipment prior to diving or if I choose to dive with equipment that may not be functioning properly. I further state that I am of lawful age and legally competent to sign this liability release, or that I have acquired the written consent of my parent or guardian. I understand the terms herein are contractual and not a mere recital, and that I have signed this Agreement of my own free act and with the knowledge that I hereby agree to waive my legal rights. I further agree that if any provision of this Agreement is found to be unenforceable or invalid, that provision shall be severed from this Agreement. The remainder of this Agreement will then be construed as though the unenforceable provision had never been contained herein. I understand and agree that I am not only giving up my right to sue the Released Parties but also any rights my heirs, assigns, or beneficiaries may have to sue the Released Parties resulting from my death. I further represent that I have the authority to do so and that my heirs, assigns, and beneficiaries will be estopped from claiming otherwise because of my representations to the Released Parties.

I, BY THIS INSTRUMENT, AGREE TO EXEMPT AND RELEASE PUERTO RICO DIVING, INC. DBA RINCON DIVING & SNORKELING, THE DIVE PROFESSIONAL(S), PADI AMERICAS, INC., AND ALL RELATED ENTITIES AS DEFINED ABOVE FROM ALL LIABILITY OR RESPONSIBILITY WHATSOEVER FOR PERSONAL INJURY, PROPERTY DAMAGE OR WRONGFUL DEATH HOWEVER CAUSED, INCLUDING BUT NOT LIMITED TO THE NEGLIGENCE OF THE RELEASED PARTIES, WHETHER PASSIVE OR ACTIVE. I HAVE FULLY INFORMED MYSELF AND MY HEIRS OF THE CONTENTS OF THIS NON-AGENCY DISCLOSURE AND ACKNOWLDGEMENT AGREEMENT AND LIABILITY RELEASE AND ASSUMPTION OF RISK AGREEMENT BY READING BOTH BEFORE SIGNING BELOW ON BEHALF OF MYSELF AND MY HEIRS.

 

If you are younger than 18 years of age SIGN HERE & on next screen, please click "MINOR" so a parent can sign with you.

 

A MINOR is a person under the age of 18 years old.


 

 

 

 

 

 

Please select who will be participating...
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First Participant's Name

First Name*

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Information
Are you a certified diver? After completing this form, give your certification card to a staff member.*
No
Yes
What is your certification level? Check all that apply. *
No diving certification
Free Diver Certification
Scuba Diver (max depth limit 40 feet)
Open Water Scuba Diver (max depth limited 60 feet)
PADI Speciality Diver
Advanced Open Water Scuba Diver (max depth limited 100 feet)
Nitrox Diver
Rescue Diver
Master Diver
Dive Master
Instructor/ITT/CD
Technical or Rebreather
Approximate # of logged dives?*
0-5
6-10
10-20
21-50
50+
First Participant's Signature*
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
Check to receive information, news, and discounts by e-mail.
A signed copy of this waiver will be sent to the email address you provide.
Witness Information

Please TYPE THE NAME OF A PERSON near you to be your WITNESS *
HOW DID YOU HEAR about us?
Click applicable box(es)
Found location by chance
Tour Review site (TripAdvisor, Google, Yelp, Expedia, etc.)
Saw a sign flyer or billboard
Social Media (facebook, twitter, instagram, etc)
Internet search
Word of mouth referral from friend, family, acquaintance
Signature of Parent or Guardian if Participant is a Minor, and by their signature they, on my behalf release all claims that both they and I have.
Parent or Guardian's Name

First Name*

Last Name*

Relationship*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Information
Are you a certified diver? After completing this form, give your certification card to a staff member.*
No
Yes
What is your certification level? Check all that apply. *
No diving certification
Free Diver Certification
Scuba Diver (max depth limit 40 feet)
Open Water Scuba Diver (max depth limited 60 feet)
PADI Speciality Diver
Advanced Open Water Scuba Diver (max depth limited 100 feet)
Nitrox Diver
Rescue Diver
Master Diver
Dive Master
Instructor/ITT/CD
Technical or Rebreather
Approximate # of logged dives?*
0-5
6-10
10-20
21-50
50+
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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