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The following Shipwreck Explorer's LLC diver liability waiver is required to be completed by each diver before a diving activity takes place.

 

THIS IS A RELEASE OF YOUR RIGHTS TO SUE SHIPWRECK EXPLORERS LLC AND/OR ANY OF ITS OWNERS, EMPLOYEES, AGENTS AND ASSIGNS AND VOLUNTEERS, THE VESSEL MOLLY V, THE OWNER OF THE VESSEL, THE CAPTAIN AND CREW OF THE VESSEL AND ALL ASSOCIATED ENTITIES (“Released Parties”) FOR PERSONAL INJURIES, WRONGFUL DEATH OR PROPERTY DAMAGE THAT MAY OCCUR DURING YOUR FORTHCOMING DIVE ACTIVITIES/TRIP AS A RESULT OF THE INHERENT RISKS ASSOCIATED WITH BOATIG, SCUBA DIVING OR TECHNICAL DIVING.

 

Please sign your INITIALS

1. I acknowledge that I am a certified scuba diver, or under an instructor’s supervision, trained in safe diving practices.  I have been advised of and fully understand the inherent hazards of scuba diving/technical diving (including semi-closed or closed circuit rebreather diving) activities.  I further ackowledge that I am trained to the level that I, myself, deem necessary to complete the scheduled dives in a safe manner.

2.  I understand that the inherent risks of scuba diving include, but are not limited to: pre-existing health issues leading to injury, drowning, panic, pressure related injuries, decompression sickness, over-expansion injuries, embolism, gas toxicity, slipping or falling while on board, being cut or struck by a boat while in the water, injuries occurring while getting on or off a boat, becoming lost or disoriented at depth, environmental factors which lead to injury, equipment problems leading to injury, buoyancy problems, fire and/or explosive hazards, improper dive planning, improper action of other divers or support personnel (including failure to rescue, recover, resuscitate, or provide medical assistance), poor judgment, along with other unforeseen risks; all of which can result in serious injury, drowning and/or death. I understand that diving with compressed air, oxygen enriched air, or other gas blends including oxygen supplied by standard open circuit scuba, semi-closed or fully closed circuit rebreathers, involves certain inherent risks including oxygen toxicity, hypoxia, hypercapnia, inert gas narcosis, and/or improper mixtures of breathing gas.

3. I understand that scuba diving is a physically strenuous activity and that I will be exerting myself during this diving excursion, and that if I am injured as a result of a heart attack, panic, hyperventilation, etc. that I expressly assume the risk of said injuries that I will not hold Shipwreck Explorers LLC / Released Parties responsible for the same.

4. I fully understand and am aware that the dive boat has limited medical facilities and that in the event of illness or injury, appropriate medical care must be summoned by radio and that treatment will be delayed until I can be transported to a proper medical care facility.  I further understand that this activity may be conducted in a remote area where medical attention may be not available.  Nevertheless, I expressly agree to proceed with this trip. 

5. Shipwreck Explorers LLC / Released Parties have made no representation to me, implied or otherwise, that they or their crew will perform safe rescues, or render first aid.  In the event I show signs of distress, call for aid or assistance I will not hold Shipwreck Explorers LLC / Released Parties responsible for their actions in attempting the performance of a rescue or first aid.

6. I affirm that I am in good mental and physical fitness for diving, and that I am not under the influence of any drugs that are contradictory to diving.  If I am taking medication(s), I affirm that I have seen a physician and have an approval to dive under the influence of the medication(s) or drug(s).

7. I affirm that will inspect all of my equipment, including all personal and/or rented equipment from Shipwreck Explorers LLC / Released Parties, prior to the diving activity and will notify Shipwreck Explorers LLC / Released Parties if any of my equipment is not working properly.  I will not hold Shipwreck Explorers LLC nor Released Parties responsible for my failure to inspect my equipment prior to diving.  I also agree to hold harmless all Released Parties should any of my dive equipment fail at any time.

8. I will pay attention to the safety briefing given by Shipwreck Explorers LLC / Released Parties.  I understand that I, myself, am responsible for my safety either above or below water.  I agree that I will plan my dives in a safe manor and execute them in a safe manor.  I agree to follow all safe diving practices that I have been trained for in my scuba diving classes. I agree that I will immediately cease and abort my dive should I feel uncomfortable at any time. 

9. I understand that sea conditions may change while we are en route to the dive site, underwater diving or any time during the dive trip and that this is a function of the environment.  I will not hold Shipwreck Explorers LLC / Released Parties responsible for weather / sea conditions over which they have no control.

10.  I acknowledge that Shipwreck Explorers LLC / Released Parties are only providing transportation from the boat's dock to a location for me to pursue my underwater activities.  The Captain or Released Parties, while assisting on board the vessel, are not providing instructions, protection from perils of scuba diving, snorkeling, or swimming and are not responsible for my safety while in the water.

11. I also understand that it is unlawful to remove any shipwreck artifact at any time.  I understand that if I do this, it is without the knowledge of anyone else, and I am solely responsible for my actions.

 

Covid-19
The novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organization. COVID-19 is reported to be extremely contagious. The state of medical knowledge is evolving, but the virus is believed to spread from person-to-person contact and/or by contact with contaminated surfaces and objects,and even possibly in the air. People reportedly can be infected and show no symptoms and therefore spread the disease. The exact methods of spread and contraction are unknown, and there is no known treatment, cure, or vaccine for COVID-19.  Evidence has shown that COVID-19 can cause serious and potentially life threatening illness and even death.

Shipwreck Explorers LLC is following these enhanced procedures to prevent the spread of the Coronavirus (COVID-19):

  • Any passenger(s) showing symptoms of COVID-19 will not be allowed aboard Molly V.
  • All passengers must observe 6ft social distance during loading/unloading of gear and while aboard Molly V boat.
  • Each passenger is required to wash or otherwise desinfect their hands upon arrival.
  • All Molly V boat surfaces will be thoroughly cleaned with appropriate disinfectant before and after each scuba diving trip.

 

12. I affirm I will not join the scheduled dive trip if I show symptoms of COVID-19.  Symptoms of COVID-19 include:

  •     Fever
  •     Fatique
  •     Dry Cough
  •     Difficulty Breathing

I agree to the following:
I, nor members of my household, have not experienced any of the symptoms listed above within the last 14 days.
I, nor members of my household, have not travelled internationally in the last 14 days.
I, nor members of my household, do not believe that we have been exposed to someone with a suspected and/or confirmed case of the Coronavirus (COVID-19).
I, nor members of my household, have not been diagnosed with the Coronavirus (COVID-19) within the last 14 days.

13. Shipwreck Explorers LLC / Released Parties cannot prevent you from becoming exposed to, contracting, or spreading COVID-19 while utilizing Shipwreck Explorers LLC services or Molly V boat.  It is not possible to prevent against the presence of any communicable disease.  Therefore, if you choose to utilize Shipwreck Explorer’s services and/or enter onto Shipwreck Explorers LLC's Molly V boat you may be exposing yourself to and/or increasing your risk of contracting or spreading COVID-19 or other communicable deseases.

14. ASSUMPTION OF RISK: I have read and understood the above warning concerning COVID-19. I hereby choose to accept the risk of contracting COVID-19 for myself in order to utilize Shipwreck Explorers LLC’s services and enter Shipwreck Explorers LLC's Molly V boat. These services are of such value to me that I accept the risk of being exposed to, contracting, and/or spreading COVID-19 in order to utilize Shipwreck Explorers LLC’s services and premises in person.

 

15. WAIVER OF LAWSUIT/LIABILITY: Having read this wavier, I agree to RELEASEfrom LIABILITYand HOLD HARMLESS Shipwreck Explorers, LLC, along with its respective officers, directors, employees, owners, members, crew members, managers, affiliates, agents, representatives, attorneys, heirs, personal representatives, successors and assigns, all individuals associated with the Boat Ride, and all individuals and entities having an interest in the boat being used for the Boat Ride, from any and all liability, claims, demands, equitable relief, damages, costs, expenses, and causes of action of any kind or character, of any type or nature whatsoever (including negligence), arising out of the Boat Ride or in connection with exposure, infection, and/or spread of COVID-19 related to utilizing Shipwreck Explorers LLC’s services and premises.

 

I have fully informed myself of the contents of this information and release by reading it before I signed it on behalf of myself or my heirs.

*It is also my intention that this release is to be continuing in nature, and will apply to any injuries or death arising out of, or related to, any diving activities I participate in with the released parties after the herein after referenced date of my signature.

Privacy Policy regarding collected information can be found at our website: https://www.shipwreckexplorers.com/privacy-policy/

 

July 14, 2020

 

 

First Participant's Name

First Name*

Middle 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

Highest Certification Level *
Certification Agency*
IANTD
NAUI
PADI
SDI, TDI, ERDI
YMCA
Other

Instructor Name and/or Instructor #
First Participant's Signature*
Second Participant's Name

First Name*

Middle Name

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

Highest Certification Level *
Certification Agency*
IANTD
NAUI
PADI
SDI, TDI, ERDI
YMCA
Other

Instructor Name and/or Instructor #
Third Participant's Name

First Name*

Middle Name

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

Highest Certification Level *
Certification Agency*
IANTD
NAUI
PADI
SDI, TDI, ERDI
YMCA
Other

Instructor Name and/or Instructor #
Fourth Participant's Name

First Name*

Middle Name

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

Highest Certification Level *
Certification Agency*
IANTD
NAUI
PADI
SDI, TDI, ERDI
YMCA
Other

Instructor Name and/or Instructor #
Fifth Participant's Name

First Name*

Middle Name

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

Highest Certification Level *
Certification Agency*
IANTD
NAUI
PADI
SDI, TDI, ERDI
YMCA
Other

Instructor Name and/or Instructor #
Sixth Participant's Name

First Name*

Middle Name

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

Highest Certification Level *
Certification Agency*
IANTD
NAUI
PADI
SDI, TDI, ERDI
YMCA
Other

Instructor Name and/or Instructor #
Seventh Participant's Name

First Name*

Middle Name

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

Highest Certification Level *
Certification Agency*
IANTD
NAUI
PADI
SDI, TDI, ERDI
YMCA
Other

Instructor Name and/or Instructor #
Eighth Participant's Name

First Name*

Middle Name

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

Highest Certification Level *
Certification Agency*
IANTD
NAUI
PADI
SDI, TDI, ERDI
YMCA
Other

Instructor Name and/or Instructor #
Ninth Participant's Name

First Name*

Middle Name

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

Highest Certification Level *
Certification Agency*
IANTD
NAUI
PADI
SDI, TDI, ERDI
YMCA
Other

Instructor Name and/or Instructor #
Tenth Participant's Name

First Name*

Middle Name

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

Highest Certification Level *
Certification Agency*
IANTD
NAUI
PADI
SDI, TDI, ERDI
YMCA
Other

Instructor Name and/or Instructor #
Parent or Guardian's Email Address

Email*

Confirm Email*
Check to receive email newsletters about upcoming dive openings and other scuba diving related updates.
Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone Number*
Insurance
Diver Insurance Type: *
DAN
Dive Assure
Other
None

If other, please specify:

Insurance Number (n/a if None): *
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*

Middle Name

Last Name*

Relationship*

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

Highest Certification Level *
Certification Agency*
IANTD
NAUI
PADI
SDI, TDI, ERDI
YMCA
Other

Instructor Name and/or 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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