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BOAT TRAVEL AND SCUBA DIVING LIABILITY RELEASE AND ASSUMPTION OF RISK AGREEMENT

I hereby affirm that I am a certified scuba diver or a student diver under the control and supervision of a certified scuba instructor, and that I thoroughly understand the hazards of scuba diving including those hazards occurring during boat travel to and from the dive site (hereinafter collectively referred to as “Excursion”). I understand that these inherent risks include, but are not limited to, drowning, air expansion injuries, decompression sickness, embolism, or other hyperbaric injuries that require treatment in a recompression chamber; 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, and other perils of the sea; all of which can result in serious injury or death. I also understand that diving with oxygen enriched air (“Enriched Air”) involves inherent risks of oxygen toxicity and/or improper mixtures of breathing gas. I understand the Excursion will be conducted at a site that is remote, either by time or distance or both, from a recompression chamber and emergency medical facilities. I still choose to proceed with the Excursion. By signing this Agreement, I certify that I am fully aware of and expressly assume these and all other risks involved in making such a boat trip and scuba dive(s), whether conducted as a recreational dive or part of a diving class. I understand and agree that neither the captain(s), assistant(s), DM(s) or Instructor(s), nor the crew or owner of the vessel; nor the vessel itself; nor PANAMA DIVE CENTER SA; nor its affiliate or subsidiary corporations; nor the owners, officers, employees, agents, contractors or assigns of the above listed individuals and/or entities; nor PADI Americas, Inc., nor its affiliate or subsidiary corporations; nor the owners, officers, employees, agents, contractors or assigns of the above listed individuals and/or entities (hereinafter “Released Parties”) may be held liable or responsible in any way for any personal injury, property damage, wrongful death or other damages to me or my family, estate, heirs or assigns that may occur as a result of my participation in this Excursion, or as a result of the negligence of any party, including the Re- leased Parties, whether passive or active. I affirm I am in good mental and physical fitness to scuba dive. I further state that I am not under the influence of alcohol or any drugs that are contradicted to diving. If I am taking medication, I affirm that I have seen a physician and have approval to dive while under the influence of the medication/drugs. I understand that skin and scuba diving are physically strenuous activities and that I will be exerting myself during this Excursion, and that if I am injured as a result of heart attack, panic, hyperventilation, drowning or any other cause, that I expressly assume the risk of said injuries and that I will not hold the Release Parties responsible for the same. I am aware that safe dive practices suggest diving with a buddy. Accordingly, it will be our responsibility to plan our dive allowing for our diving limitations and the prevailing water conditions and environment. I will not hold the Released Parties responsible for my failure to safely plan my dive, dive my plan, maintain buddy contact and follow the instructions of the dive supervisor/vessel crew, including the dive briefing. I affirm it is my responsibility to inspect all of my equipment prior to the Excursion and will notify the Released Parties if any of my equipment is not working properly. I will not hold the Released Parties responsible for my failure to inspect my equipment prior to diving. I further state that I am of lawful age and legally competent to sign thisAgreement, or that I have obtained the written consent of my parent or guardian. I understand the terms herein are contractual and not a mere recital, and that I have signed this Agreement of my own free act and with the knowledge that I hereby agree to waive my legal rights. I further agree that if any provision of this Agreement if found to be unenforceable or invalid, that provision shall be severed from this Agreement. The remainder of this Agreement will then be construed as though the unenforceable provision had never been contained herein. I understand and agree that I am not only giving up my right to sue the Released Parties but also any rights my heirs, assigns or beneficiaries my have to sue the Release Parties resulting from my death. I further represent that I have the authority to do so and my heirs, assigns and beneficiaries will be estopped from claiming otherwise because of my representations to the Re- leased Parties. I, BY THIS INSTRUMENT, AGREE TO EXEMPT AND RELEASE ALL THE ABOVE LISTED ENTITIES AND/OR INDIVIDUALS FROM ALL LIABILITY AND RESPONSIBILITY FOR PERSONAL INJURY, PROPERTY DAMAGE OR WRONGFUL DEATH, HOWEVER CAUSED, INCLUDING BUT NOT LIMITED TO, PRODUCT LIABILITY OR THE NEGLIGENCE OF THE RELEASED PARTIES, WHETHER PASSIVE OR ACTIVE. I HAVE FULLY INFORMED MYSELF AND MY HEIRS OF THE CONTENTS OF THIS LIABILITY RELEASE AND ASSUMPTION OF RISK AGREEMENT BY READING IT BEFORE I SIGNED IT ON BEHALF OF MY HEIRS AND MYSELF.

I Agree

Payment Disclosure: I understand that full payment is due latest the day prior to the tour. If no payment is made, the dive center may give away my spot to someone else. Furthermore, I understand that the payment made is non-refundable if cancellation occurs less than 48 hours prior to the trip. In signing this, I agree to the above-mentioned payment policy.

I Agree

Equipment Rental: I hereby affirm that any equipment lent to be for the duration of my dive trip is under my responsibility and I understand that I will be made liable in case of loss or damage. Shoul I not return the items in the same condition as they were given to me, I agree that the following charges will apply: mask $40, fins $50, wetsuit $230, BCD $250, weightbelt $10 + $3 per pound lost, dive computer $250.

I Agree

Today's Date: November 22, 2019

First Diver's Name

First Name*

Last Name*
First Diver's Date of Birth*
First Diver's Information

When are you diving with us? (indicate the first day if it's for multiple days) *
Country of origin*
Are your a Panamanian resident?*
No
Yes
Certification Agency*

Certification No. *
Certification Level*

Approximately, how many dives have you done so far? *

When was your last dive *
Do you need a mask?*
No
Yes
Do you need fins?*
Do you need a wetsuit?*
Do you need a BCD?*

How much do you weigh? (Please indicate in kilograms. This is so we can estimate how much led you will need) *
Do you have your own dive computer?*
No
Yes
Which sandwich you would like for lunch?*
We are trying to use less plastic to stop contributing to the ever-increasing pollution of our planet. The tap water is safe to drink and is offered in disinfected aluminium and/or reusable plastic bottles. Would you like to drink this water?*

Which hotel/hostel are you staying at? (Please write TBC if you are booking a package or have not made a reservation yet) *
How did you hear about us?*

Insurance Carrier (this can be your dive, travel or health insurance) *

Policy Number *

Emergency contact's name (this should NOT be a person you are diving with) *

Emergency contact's phone number *
First Diver's Signature*
Second Diver's Name

First Name*

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

When are you diving with us? (indicate the first day if it's for multiple days) *
Country of origin*
Are your a Panamanian resident?*
No
Yes
Certification Agency*

Certification No. *
Certification Level*

Approximately, how many dives have you done so far? *

When was your last dive *
Do you need a mask?*
No
Yes
Do you need fins?*
Do you need a wetsuit?*
Do you need a BCD?*

How much do you weigh? (Please indicate in kilograms. This is so we can estimate how much led you will need) *
Do you have your own dive computer?*
No
Yes
Which sandwich you would like for lunch?*
We are trying to use less plastic to stop contributing to the ever-increasing pollution of our planet. The tap water is safe to drink and is offered in disinfected aluminium and/or reusable plastic bottles. Would you like to drink this water?*

Which hotel/hostel are you staying at? (Please write TBC if you are booking a package or have not made a reservation yet) *
How did you hear about us?*

Insurance Carrier (this can be your dive, travel or health insurance) *

Policy Number *

Emergency contact's name (this should NOT be a person you are diving with) *

Emergency contact's phone number *
Third Diver's Name

First Name*

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

When are you diving with us? (indicate the first day if it's for multiple days) *
Country of origin*
Are your a Panamanian resident?*
No
Yes
Certification Agency*

Certification No. *
Certification Level*

Approximately, how many dives have you done so far? *

When was your last dive *
Do you need a mask?*
No
Yes
Do you need fins?*
Do you need a wetsuit?*
Do you need a BCD?*

How much do you weigh? (Please indicate in kilograms. This is so we can estimate how much led you will need) *
Do you have your own dive computer?*
No
Yes
Which sandwich you would like for lunch?*
We are trying to use less plastic to stop contributing to the ever-increasing pollution of our planet. The tap water is safe to drink and is offered in disinfected aluminium and/or reusable plastic bottles. Would you like to drink this water?*

Which hotel/hostel are you staying at? (Please write TBC if you are booking a package or have not made a reservation yet) *
How did you hear about us?*

Insurance Carrier (this can be your dive, travel or health insurance) *

Policy Number *

Emergency contact's name (this should NOT be a person you are diving with) *

Emergency contact's phone number *
Fourth Diver's Name

First Name*

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

When are you diving with us? (indicate the first day if it's for multiple days) *
Country of origin*
Are your a Panamanian resident?*
No
Yes
Certification Agency*

Certification No. *
Certification Level*

Approximately, how many dives have you done so far? *

When was your last dive *
Do you need a mask?*
No
Yes
Do you need fins?*
Do you need a wetsuit?*
Do you need a BCD?*

How much do you weigh? (Please indicate in kilograms. This is so we can estimate how much led you will need) *
Do you have your own dive computer?*
No
Yes
Which sandwich you would like for lunch?*
We are trying to use less plastic to stop contributing to the ever-increasing pollution of our planet. The tap water is safe to drink and is offered in disinfected aluminium and/or reusable plastic bottles. Would you like to drink this water?*

Which hotel/hostel are you staying at? (Please write TBC if you are booking a package or have not made a reservation yet) *
How did you hear about us?*

Insurance Carrier (this can be your dive, travel or health insurance) *

Policy Number *

Emergency contact's name (this should NOT be a person you are diving with) *

Emergency contact's phone number *
Fifth Diver's Name

First Name*

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

When are you diving with us? (indicate the first day if it's for multiple days) *
Country of origin*
Are your a Panamanian resident?*
No
Yes
Certification Agency*

Certification No. *
Certification Level*

Approximately, how many dives have you done so far? *

When was your last dive *
Do you need a mask?*
No
Yes
Do you need fins?*
Do you need a wetsuit?*
Do you need a BCD?*

How much do you weigh? (Please indicate in kilograms. This is so we can estimate how much led you will need) *
Do you have your own dive computer?*
No
Yes
Which sandwich you would like for lunch?*
We are trying to use less plastic to stop contributing to the ever-increasing pollution of our planet. The tap water is safe to drink and is offered in disinfected aluminium and/or reusable plastic bottles. Would you like to drink this water?*

Which hotel/hostel are you staying at? (Please write TBC if you are booking a package or have not made a reservation yet) *
How did you hear about us?*

Insurance Carrier (this can be your dive, travel or health insurance) *

Policy Number *

Emergency contact's name (this should NOT be a person you are diving with) *

Emergency contact's phone number *
Sixth Diver's Name

First Name*

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

When are you diving with us? (indicate the first day if it's for multiple days) *
Country of origin*
Are your a Panamanian resident?*
No
Yes
Certification Agency*

Certification No. *
Certification Level*

Approximately, how many dives have you done so far? *

When was your last dive *
Do you need a mask?*
No
Yes
Do you need fins?*
Do you need a wetsuit?*
Do you need a BCD?*

How much do you weigh? (Please indicate in kilograms. This is so we can estimate how much led you will need) *
Do you have your own dive computer?*
No
Yes
Which sandwich you would like for lunch?*
We are trying to use less plastic to stop contributing to the ever-increasing pollution of our planet. The tap water is safe to drink and is offered in disinfected aluminium and/or reusable plastic bottles. Would you like to drink this water?*

Which hotel/hostel are you staying at? (Please write TBC if you are booking a package or have not made a reservation yet) *
How did you hear about us?*

Insurance Carrier (this can be your dive, travel or health insurance) *

Policy Number *

Emergency contact's name (this should NOT be a person you are diving with) *

Emergency contact's phone number *
Seventh Diver's Name

First Name*

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

When are you diving with us? (indicate the first day if it's for multiple days) *
Country of origin*
Are your a Panamanian resident?*
No
Yes
Certification Agency*

Certification No. *
Certification Level*

Approximately, how many dives have you done so far? *

When was your last dive *
Do you need a mask?*
No
Yes
Do you need fins?*
Do you need a wetsuit?*
Do you need a BCD?*

How much do you weigh? (Please indicate in kilograms. This is so we can estimate how much led you will need) *
Do you have your own dive computer?*
No
Yes
Which sandwich you would like for lunch?*
We are trying to use less plastic to stop contributing to the ever-increasing pollution of our planet. The tap water is safe to drink and is offered in disinfected aluminium and/or reusable plastic bottles. Would you like to drink this water?*

Which hotel/hostel are you staying at? (Please write TBC if you are booking a package or have not made a reservation yet) *
How did you hear about us?*

Insurance Carrier (this can be your dive, travel or health insurance) *

Policy Number *

Emergency contact's name (this should NOT be a person you are diving with) *

Emergency contact's phone number *
Eighth Diver's Name

First Name*

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

When are you diving with us? (indicate the first day if it's for multiple days) *
Country of origin*
Are your a Panamanian resident?*
No
Yes
Certification Agency*

Certification No. *
Certification Level*

Approximately, how many dives have you done so far? *

When was your last dive *
Do you need a mask?*
No
Yes
Do you need fins?*
Do you need a wetsuit?*
Do you need a BCD?*

How much do you weigh? (Please indicate in kilograms. This is so we can estimate how much led you will need) *
Do you have your own dive computer?*
No
Yes
Which sandwich you would like for lunch?*
We are trying to use less plastic to stop contributing to the ever-increasing pollution of our planet. The tap water is safe to drink and is offered in disinfected aluminium and/or reusable plastic bottles. Would you like to drink this water?*

Which hotel/hostel are you staying at? (Please write TBC if you are booking a package or have not made a reservation yet) *
How did you hear about us?*

Insurance Carrier (this can be your dive, travel or health insurance) *

Policy Number *

Emergency contact's name (this should NOT be a person you are diving with) *

Emergency contact's phone number *
Ninth Diver's Name

First Name*

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

When are you diving with us? (indicate the first day if it's for multiple days) *
Country of origin*
Are your a Panamanian resident?*
No
Yes
Certification Agency*

Certification No. *
Certification Level*

Approximately, how many dives have you done so far? *

When was your last dive *
Do you need a mask?*
No
Yes
Do you need fins?*
Do you need a wetsuit?*
Do you need a BCD?*

How much do you weigh? (Please indicate in kilograms. This is so we can estimate how much led you will need) *
Do you have your own dive computer?*
No
Yes
Which sandwich you would like for lunch?*
We are trying to use less plastic to stop contributing to the ever-increasing pollution of our planet. The tap water is safe to drink and is offered in disinfected aluminium and/or reusable plastic bottles. Would you like to drink this water?*

Which hotel/hostel are you staying at? (Please write TBC if you are booking a package or have not made a reservation yet) *
How did you hear about us?*

Insurance Carrier (this can be your dive, travel or health insurance) *

Policy Number *

Emergency contact's name (this should NOT be a person you are diving with) *

Emergency contact's phone number *
Tenth Diver's Name

First Name*

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

When are you diving with us? (indicate the first day if it's for multiple days) *
Country of origin*
Are your a Panamanian resident?*
No
Yes
Certification Agency*

Certification No. *
Certification Level*

Approximately, how many dives have you done so far? *

When was your last dive *
Do you need a mask?*
No
Yes
Do you need fins?*
Do you need a wetsuit?*
Do you need a BCD?*

How much do you weigh? (Please indicate in kilograms. This is so we can estimate how much led you will need) *
Do you have your own dive computer?*
No
Yes
Which sandwich you would like for lunch?*
We are trying to use less plastic to stop contributing to the ever-increasing pollution of our planet. The tap water is safe to drink and is offered in disinfected aluminium and/or reusable plastic bottles. Would you like to drink this water?*

Which hotel/hostel are you staying at? (Please write TBC if you are booking a package or have not made a reservation yet) *
How did you hear about us?*

Insurance Carrier (this can be your dive, travel or health insurance) *

Policy Number *

Emergency contact's name (this should NOT be a person you are diving with) *

Emergency contact's phone number *
Parent or Guardian's Email Address

Email*
A signed copy of this waiver will be sent to the email address you provide.
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*
Parent or Guardian's Date of Birth*
Parent or Guardian's Information

When are you diving with us? (indicate the first day if it's for multiple days) *
Country of origin*
Are your a Panamanian resident?*
No
Yes
Certification Agency*

Certification No. *
Certification Level*

Approximately, how many dives have you done so far? *

When was your last dive *
Do you need a mask?*
No
Yes
Do you need fins?*
Do you need a wetsuit?*
Do you need a BCD?*

How much do you weigh? (Please indicate in kilograms. This is so we can estimate how much led you will need) *
Do you have your own dive computer?*
No
Yes
Which sandwich you would like for lunch?*
We are trying to use less plastic to stop contributing to the ever-increasing pollution of our planet. The tap water is safe to drink and is offered in disinfected aluminium and/or reusable plastic bottles. Would you like to drink this water?*

Which hotel/hostel are you staying at? (Please write TBC if you are booking a package or have not made a reservation yet) *
How did you hear about us?*

Insurance Carrier (this can be your dive, travel or health insurance) *

Policy Number *

Emergency contact's name (this should NOT be a person you are diving with) *

Emergency contact's phone number *
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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