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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, Jitka Hanakova, its crew, servants, agents, employees, or boats whether owned, operated, or chartered (hereinafter "Released Parties") for personal injuries or wrongful death that may occur during the forthcoming dive activities as a result of the negligence of the released parties.

 

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 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 scuba diving has inherent risks and dangers associated therewith including, but not limited to, risks associated with equipment failure, being struck by surface craft, perils of the sea, acts of fellow divers and I specifically assume all risks of my dive activities whether foreseen or unforeseen.

3. 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).

4. I 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.

5. 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. 

6. If I become distressed on the surface, I will immediately drop my weight belt if applicable, and inflate my BC for flotation assistance.

7. 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 or Released Parties responsible for weather / sea conditions over which they have no control.

8.  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.

9. I understand that even if I follow all of the appropriate dive practices, there is still some risk of my sustaining decompression sickness, embolism, or other hyperbaric injuries, I expressly assume the risk of said injuries.

10. 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 or Released Parties responsible for the same.

11. 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. 

12. 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 or call for aid I would like assistance and will not hold Shipwreck Explorers LLC or Released Parties responsible for their actions in attempting the performance of a rescue or first aid.

13. 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.

14. By way of my signature on this document it is my express intention to give up all rights to sue the Shipwreck Explorers LLC / Released Parties.  I further understand that by way of my signature I fully agree to hold harmless Shipwreck Explorers LLC / all Released Parties and that it is my wish that in case of me being injured or killed that my heirs hold harmless Shipwreck Explorers LLC / all Released Parties / Entities.  I am with my signature assuming any and all risk in regards to my participation here today.  I further agree that I have signed this document on my own free will and fully understand what I have read.

 

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/

 

September 23, 2019

 

 

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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