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

 

EXPRESS ASSUMPTION OF RISK ASSOCIATED WITH DIVING AND RELATED ACTIVITIES.

This is a release of your rights to sue Cape Ann Charter and Harvest Inc., its servants, agents or employees, (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 AGREE

1. I acknowledge that I am a certified scuba diver, or under an instructor’s supervision, trained in safe diving practices and will remain with my buddy or instructor at all times. 

I Agree

2. I understand snorkeling/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/snorkelers and I specifically assume all risks of my snorkeling/dive activities whether foreseen or unforeseen

I Agree

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 I affirm that I have seen a physician and have approval to dive under the influence of the medication/drugs. 

I Agree

4. I will inspect all of my equipment and any equipment I rented from Cape Ann Charter and Harvest In. c. prior to the activity and will notify the above listed individuals if any of my equipment is not working properly. I will not hold Cape Ann Charter and Harvest Inc. nor any of the above listed individuals responsible for my failure to inspect my equipment prior to diving.

I Agree

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

I Agree

6. I also understand that sea conditions may change while we are in route to the dive site, underwater diving or any time during the dive trip and that this is the function of the environment. I will not hold Cape Ann Charter and Harvest Inc. or any of the above listed individuals responsible for weather/ sea conditions over which they have no control. 

I Agree

7. I acknowledge that Cape Ann Charter and Harvest Inc. is providing transportation only from their dock to a location for me to pursue my underwater activities and that the captain and the divemaster or other agents or assigns, while assisting on board the vessel are not providing instruction, protection from perils of swimming and scuba diving/snorkeling and are not responsible for my safety while in the water

I Agree

8. I understand that even though 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. 

I Agree

9. 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 and that I will not hold the above listed individuals responsible for the same. 

I Agree

10. I also 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 Agree

11. As a recommendation of scuba training agencies, I understand that I should take a refresher course if I have not been scuba diving for several months. 

I Agree

12. Cape Ann Charter and Harvest Inc. has 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 Cape Ann Charter and Harvest Inc. its crew, dive boats, or passengers responsible for their actions in attempting the performance of a rescue or first aid.

I Agree

It is the intention of Participant to exempt and release Cape Ann Charter and Harvest Inc. its agents, servants and employees from all liability whatsoever for personal injury, property damage, and wrongful death caused by the simple or gross negligence of the released parties. 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/Snorkeling activities I participate in for the duration of ONE YEAR from the date of this release.

I HAVE READ THIS AGREEMENT, I UNDERSTAND THIS AGREEMENT, I AGREE TO BE BOUND BY IT.

I Agree

Today's Date July 20, 2019

First Participant's Name

First Name*

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Information

What organization are you certified through? *
What is your level of certification?*
Do you have cold water diving experience?*
No
Yes

If you are part of a class please list the name of your instructor.
First Participant's Signature*
Second Participant's Name

First Name*

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

What organization are you certified through? *
What is your level of certification?*
Do you have cold water diving experience?*
No
Yes

If you are part of a class please list the name of your instructor.
Third Participant's Name

First Name*

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

What organization are you certified through? *
What is your level of certification?*
Do you have cold water diving experience?*
No
Yes

If you are part of a class please list the name of your instructor.
Fourth Participant's Name

First Name*

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

What organization are you certified through? *
What is your level of certification?*
Do you have cold water diving experience?*
No
Yes

If you are part of a class please list the name of your instructor.
Fifth Participant's Name

First Name*

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

What organization are you certified through? *
What is your level of certification?*
Do you have cold water diving experience?*
No
Yes

If you are part of a class please list the name of your instructor.
Sixth Participant's Name

First Name*

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

What organization are you certified through? *
What is your level of certification?*
Do you have cold water diving experience?*
No
Yes

If you are part of a class please list the name of your instructor.
Seventh Participant's Name

First Name*

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

What organization are you certified through? *
What is your level of certification?*
Do you have cold water diving experience?*
No
Yes

If you are part of a class please list the name of your instructor.
Eighth Participant's Name

First Name*

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

What organization are you certified through? *
What is your level of certification?*
Do you have cold water diving experience?*
No
Yes

If you are part of a class please list the name of your instructor.
Ninth Participant's Name

First Name*

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

What organization are you certified through? *
What is your level of certification?*
Do you have cold water diving experience?*
No
Yes

If you are part of a class please list the name of your instructor.
Tenth Participant's Name

First Name*

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

What organization are you certified through? *
What is your level of certification?*
Do you have cold water diving experience?*
No
Yes

If you are part of a class please list the name of your instructor.
Parent or Guardian's Email Address

Email*

Confirm Email*
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*

Relationship*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Information

What organization are you certified through? *
What is your level of certification?*
Do you have cold water diving experience?*
No
Yes

If you are part of a class please list the name of your 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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