Certified Diver Liability & Release(Good for 1 year-DO NOT keep filling out waivers if you get a reminder)
RELEASE OF LIABILITY, WAIVER OF CLAIMS, EXPRESS ASSUMPTION OF RISK AND INDEMNITY AGREEMENT
PLEASE READ AND BE CERTAIN YOU UNDERSTAND THE IMPLICATIONS OF SIGNING
EXPRESS ASSUMPTION OF RISK ASSOCIATED WITH DIVING AND RELATED ACTIVITIES
I do hereby affirm and acknowledge that I have been fully informed of the inherent hazards and risks associated with Snorkeling, Skin and/or Scuba diving. I fully understand that these risks can lead to severe injury and even loss of life. I understand that diving operations may be conducted at a site that is remote from a recompression chamber and competent medical assistance. Nevertheless, I choose to proceed even in the absence of a recompression chamber and competent medical assistance. Additionally, I understand that there are also risks associated with dive travel, including, but not limited to the possible injury or loss of life as a result of a dive boat accident, as well as travel to and from dive sites. Despite the potential hazards and dangers associated with the activity of diving, I wish to proceed and I freely accept and expressly assume all risk, dangers and hazards that may arise from diving activities which could result in personal injury, loss of life and property damage to me.
RELEASE OF LIABILITY, WAIVER OF CLAIMS AND INDEMNITY AGREEMENT:
In consideration of being allowed to participate in Snorkeling, Skin and/or Scuba Diving activities as well as the use of any of the facilities and the use of the equipment of the below listed releasees, I hereby agree as follows:
1. TO WAIVE AND RELEASE ANY AND ALL CLAIMS based upon negligence, active or passive with the exception of intentional, wanton or willful misconduct that I may have in the future against any of the following named persons or entities (hereafter referred to as Releasees):
(Instructor/s): All Staff & Instructors
(Facility/ies): Culebra Divers
2. To release the releasees, their officers, directors, employees, representatives, agents and volunteers, from liability and responsibility, whatsoever, for any claims or causes of action that I, my estate, heirs executors or assigns may have for personal injury, property damage or wrongful death arising from Snorkeling, Skin and / or Scuba diving activities whether caused by active or passive negligence of the releasees or otherwise with the exception of gross negligence. By executing this document, I agree to hold the releasees harmless for any injury or loss of life which may occur to me during Snorkeling, Skin and/or Scuba diving activities and/or instruction.
3. By entering into this agreement, I am not relying on any oral or written representation or statements made by the releasees, other than what is set forth in this agreement. I further agree that this Agreement shall be governed by and interpreted in accordance with the laws of the State of California, United States of America.
4. If any provision, section, subsection, clause or phrase of this release is found to be unenforceable or invalid, that portion shall be severed from this contract. The remainder of this contract will then be construed as though the unenforceable portion had never been contained in this document.
I hereby declare that I am of legal age and am competent to sign this Agreement or, if not, that my parent or legal guardian shall sign on my behalf, and that my parent or legal guardian is in complete understanding and concurrence with this agreement.
I HAVE READ THIS AGREEMENT, I UNDERSTAND IT, I AGREE TO BE BOUND BY IT.
Signature Of Participant / 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.
Date: February 6, 2023
HEALTH DECLARATION DISCLOSURE - COVID 19
Read this statement prior to signing it. You must complete this additional medical questionnaire to enroll in a diver training program or to participate in any diving activity. If you are a minor, you must have this statement signed by your parent or guardian.
DIVER MEDICAL QUESTIONNAIRE
The purpose of this medical questionnaire is to ensure that you are medically fit to dive. Please answer the following questions with a YES or NO. A positive response means that there may be a preexisting condition that could affect your safety while diving. If any of these items apply to you, you should consult with a physician, preferably a specialist in diving medicine, prior to participating in diving activities.
ADDITIONAL DECLARATIONS / COVID-19
I WILL, if asked, wear a protective mask at all times while participating in the diving training / activities arranged by Culebra Divers Culebra Divers staff members, and will take all reasonable preventive steps that may be recommended by Culebra Divers staff members, or any relevant public authority.
I WILL accept and observe all instructions by Culebra Divers staff members and intend to abide by all existing regulations required tohelp prevent the risk of transmission, including having my temperature taken prior to participating in any diving activities.
I ACKNOWLEDGE and ACCEPT that this declaration will be consideredas my consent to Culebra Divers to retain this declaration and disclose it to any relevant authority or service provider for the purposes of ensuring the safety of any third parties that may come in contact with me prior to, during, and after any diving activity.
COVID-19 shares many of the same symptoms as other serious viral pneumonias that require a period of convalescence before returning to full activities – a process that can take weeks or months depending on symptom severity (1).
MEDICAL RECOMMENDATIONS (2, 3):
Divers who have tested positive for COVID-19 but have remained completely asymptomatic, should wait ONE month before resuming diving.
Divers who have had symptomatic COVID-19, should wait at least THREE months before applying for fit-to-dive clearance conducted by a medical professional.
Divers who have been hospitalized with or because of pulmonary symptoms in relation to COVID-19, should wait at least THREE months before applying for fit-to-dive clearance conducted by a medical professional, with complete pulmonary function testing and an exercise test with peripheral oxygen saturation measurement as well as a high resolution CT scan of the lungs.
Divers who have been hospitalized with or because of cardiac problems in relation to COVID-19, should wait at least THREE months before applying for fit-to-dive clearance conducted by a medical professional that includes a cardiac evaluation, including echocardiography and an exercisetest (exerciseelectrocardiography).
(1) Return to Diving Post COVID-19 - Issued by the Undersea and Hyperbaric Medical Society (UHMS) in the USA
(2) Diving after COVID-19 pulmonary infection - Position statement of the Belgian Society for Diving and Hyperbaric Medicine (SBMHS-BVOOG)
(3) Recreational and professional diving after the Coronavirus disease (COVID-19) outbreak - Position statement of EUBS & ECHM
Today's Date: February 6, 2023