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COMPLETE LIABILITY RELEASE AND COVENANT NOT TO SUE
READ CAREFULLY BEFORE SIGNING

In consideration for being permitted to receive an air fill of a scuba compressed gas cylinder or other cylinder (hereinafter “cylinder”) from DIVE GEORGIA, LLC (hereinafter “DIVE GEORGIA”), I hereby expressly and contractually promise and agree as follows:

1.      The cylinder will never be used, by me, for scuba diving.

2.      I will never allow the cylinder to be used for diving, by anyone else. 

I understand and am aware of the inherent dangers associated with the use of compressed air/gasses and specifically assume those risks. I expressly release DIVE GEORGIA, its employees, owners, owner’s heirs, agents and assigns, for any and all liability arising as a consequence of any and all personal injury, property damage or wrongful death caused by or associated with the use of the cylinder, on behalf of myself, my heirs and anyone else I expose to the dangers associated with the compressed air/gasses. 

I expressly agree to indemnify and hold harmless DIVE GEORGIA, its employees, owners, owner’s heirs, agents, and assigns, for any personal injury, property damage or wrongful death to myself or to others as a consequence of the use of the cylinder.

I understand the purpose of signing this release is to give up all rights to sue the above-named dive store, its employees, owners, owner’s heirs, agents, assigns, or insurers and that this document constitutes a legally binding contract. This document is to be interpreted as broadly as possible, rather than narrowly construed, in the event of a legal dispute.

I have read and understand the foregoing in its entirety and agree to the terms and conditions herein above set forth on behalf of myself, my estate, my heirs, and my personal representative(s). I have had an opportunity to ask questions regarding this document prior to signing the same.

First Customer's Name

First Name*

Last Name*

Phone*
First Customer's Date of Birth*
I certify that I am 18 years of age or older
First Customer's Signature*
Second Customer's Name

First Name*

Last Name*
Second Customer's Date of Birth*
Third Customer's Name

First Name*

Last Name*
Third Customer's Date of Birth*
Fourth Customer's Name

First Name*

Last Name*
Fourth Customer's Date of Birth*
Fifth Customer's Name

First Name*

Last Name*
Fifth Customer's Date of Birth*
Sixth Customer's Name

First Name*

Last Name*
Sixth Customer's Date of Birth*
Seventh Customer's Name

First Name*

Last Name*
Seventh Customer's Date of Birth*
Eighth Customer's Name

First Name*

Last Name*
Eighth Customer's Date of Birth*
Ninth Customer's Name

First Name*

Last Name*
Ninth Customer's Date of Birth*
Tenth Customer's Name

First Name*

Last Name*
Tenth Customer's Date of Birth*
Parent or Guardian's Email Address

Email*

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Parent or Guardian's Driver's License / ID Card

Driver's License / ID Card Number*

Issuing State*
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*
I certify that I am 18 years of age or older
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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