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Liability Release and Assumption of Risk Agreement

  Please read and sign below    

I hereby affirm that I am aware that skin and scuba diving have inherent risks which may result in serious injury or death.

I understand that diving with compressed air involves certain inherent risks including, but not limited to: Decompression sickness, embolism, or other hyperbaric/air expansion injury that require treatment in a decompression chamber. I further understand that certain events, both boat diving trips and shore diving trips, may be facilitated at a site that is remote, either by time or distance or both, from such a decompression chamber. I still choose to proceed with such dives, and all other Power Scuba events, in spite of the possible absence of a decompression chamber in close proximity to the dive/activity site.

I understand that neither Power Scuba (a corporation), William P. Powers II, Power Scuba Directors, Power Scuba Officers, nor any Power Scuba organizer (hereafter called the Released Parties) may be held liable or responsible in any way for any injury, death, or other damages to me, my family, estate, heirs or assigns that may occur as a result of my participation in Power Scuba group events and activities or as a result of the negligence of any party, including the Released Parties, whether passive or active.

In consideration of being allowed to participate in Power Scuba events and activities, I hereby personally assume all risks of said events and activities, whether foreseen or unforeseen, that may befall me while I am a participant in Power Scuba activities including, but not limited to, land-based events, confined water events, and open water events/activities.

I further release, exempt, and hold harmless Power Scuba, William P. Powers II, and all other Released Parties from any claim or lawsuit by me, my family, estate, heirs or assigns, arising out of my free membership in Power Scuba including both claims arising during Power Scuba events and activities or afterward.

I also understand that skin diving and scuba diving are physically strenuous activities and that I will be exerting myself during Power Scuba events and activities 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 Released Parties responsible for the same.

I further state that I am a fully certified scuba diver (deriving my certification from a nationally or internationally recognized agency), am medically fit to dive, and have no medical condition counter-indicative to scuba diving -or- that I have submitted to a Power Scuba staff member a signed (by my doctor) doctor's waiver that addresses any medical conditions I may have and declares me medically fit to dive.

I understand that I, and no one else, am responsible for my safety while engaging in Power Scuba events and activities. I am trained and have the necessary skills for any event/activity I choose to undertake. I affirm that no professional or teaching/training relationship exists, either real or imagined, between myself and the Released Parties.

I further state that I am of lawful age and legally competent to sign this liability release, or that I have acquired 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 will and with the knowledge that I hereby agree to waive my legal rights.

I further agree that if any provision of this Agreement is found to be unenforceable or invalid, that provision shall be severed from this Agreement. The remainder of the 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 may have to sue the Released Parties resulting from my death.

I further represent I have the authority to do so and that my heirs, assigns, or beneficiaries will be estopped from claiming otherwise because of my representations to the Released Parties.

I BY THIS INSTRUMENT AGREE TO EXEMPT AND RELEASE, FROM NOW UNTIL I REVOKE THIS AGREEMENT IN WRITING, POWER SCUBA, WILLIAM P. POWERS II, POWER SCUBA DIRECTORS, POWER SCUBA OFFICERS, POWER SCUBA ORGANIZERS, AND ALL RELATED ENTITIES AS DEFINED ABOVE, FROM ALL LIABILITY OR RESPONSIBILITY WHATSOEVER FOR PERSONAL INJURY, PROPERTY DAMAGE, OR DEATH HOWEVER CAUSED, INCLUDING, BUT NOT LIMITED TO, THE NEGLIGENCE OF THE RELEASED PARTIES, WHETHER PASSIVE OR ACTIVE.

I HAVE FULLY INFORMED MYSELF OF THE CONTENTS OF THIS LIABILITY RELEASE AND ASSUMPTION OF RISK AGREEMENT BY READING IT BEFORE I SIGNED IT ON BEHALF OF MYSELF AND MY HEIRS.

I ACKNOWLEDGE THE CONTAGIOUS NATURE OF COVID-19 AND VOLUNTARILY ASSUME THE RISK THAT I MAY BE EXPOSED TO OR INFECTED BY COVID-19 BY PARTICIPATING ON ANY ACTIVITIES AND THAT SUCH EXPOSURE OR INFECTION MAY RESULT IN PERSONAL INJURY, ILLNESS, PERMANENT DISABILITY, OR DEATH. I UNDERSTAND THAT THE RISK OF BECOMING EXPOSED TO OR INFECTED BY COVID-19 WHILE ENGAGED IN A POWER SCUBA EVENT IS POSSIBLE AND MAY RESULT FROM THE ACTIONS, OMISSIONS, OR NEGLIGENCE OF MYSELF AND OTHERS, INCLUDING, BUT NOT LIMITED TO, POWER SCUBA STAFF AND MEMBERS AND THEIR FAMILIES. I VOLUNTARILY AGREE TO ASSUME ALL COVID-RELATED RISKS AND ACCEPT SOLE RESPONSIBILITY FOR ANY COVID-RELATED INJURY TO MYSELF OR MY FAMILY. Additionally, I will not attend any in-person Power Scuba event if I have tested positive for Covid-19, am showing symptoms of infection, or have had known exposure to the virus within the past 14 days. I agree to follow all pandemic rules and regulations imposed by San Diego County and the State of California.

PLEASE NOTE that you are submitting an electronic form. By checking the box below, you are also agreeing that by typing your name into the box below, you are electronically signing this document and that this constitutes a binding agreement and that all information provided in the form is correct. *

I have read, understand, and agree to the terms listed in this Liability Release and Assumption of Risk Agreement.

By submitting this form, I am applying my electronic signature to this Liability Release and Assumption of Risk Agreement. I agree that my electronic signature is the legally binding equivalent of my handwritten signature on paper. I will not, at any future time, claim that my electronic signature is not legally binding or enforceable. By electronically signing and submitting this agreement, I 1) acknowledge that I have read and fully understand the terms of the agreement; 2) voluntarily agree to be bound by this agreement; and 3) certify that I am 18 years of age or older. My signature applies to all terms of this contract.

I understand that I will receive an email version of this agreement after it is signed at the email address I have provided if I have chosen to do so by selecting the option below. I understand that if I wish to sign a hard copy of this agreement instead of an electronic version, I must contact the party that requires my signature on this agreement directly.

First Participant's Name

First Name*

Middle Name

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Diving Certification Level

Please add your highest certification level (ie. if you have OW and AOW, just enter AOW)
First Participant's Signature*
Second Participant's Name

First Name*

Middle Name

Last Name*

Phone*
Second Participant's Date of Birth*
Second Participant's Diving Certification Level

Please add your highest certification level (ie. if you have OW and AOW, just enter AOW)
Third Participant's Name

First Name*

Middle Name

Last Name*

Phone*
Third Participant's Date of Birth*
Third Participant's Diving Certification Level

Please add your highest certification level (ie. if you have OW and AOW, just enter AOW)
Fourth Participant's Name

First Name*

Middle Name

Last Name*

Phone*
Fourth Participant's Date of Birth*
Fourth Participant's Diving Certification Level

Please add your highest certification level (ie. if you have OW and AOW, just enter AOW)
Fifth Participant's Name

First Name*

Middle Name

Last Name*

Phone*
Fifth Participant's Date of Birth*
Fifth Participant's Diving Certification Level

Please add your highest certification level (ie. if you have OW and AOW, just enter AOW)
Sixth Participant's Name

First Name*

Middle Name

Last Name*

Phone*
Sixth Participant's Date of Birth*
Sixth Participant's Diving Certification Level

Please add your highest certification level (ie. if you have OW and AOW, just enter AOW)
Seventh Participant's Name

First Name*

Middle Name

Last Name*

Phone*
Seventh Participant's Date of Birth*
Seventh Participant's Diving Certification Level

Please add your highest certification level (ie. if you have OW and AOW, just enter AOW)
Eighth Participant's Name

First Name*

Middle Name

Last Name*

Phone*
Eighth Participant's Date of Birth*
Eighth Participant's Diving Certification Level

Please add your highest certification level (ie. if you have OW and AOW, just enter AOW)
Ninth Participant's Name

First Name*

Middle Name

Last Name*

Phone*
Ninth Participant's Date of Birth*
Ninth Participant's Diving Certification Level

Please add your highest certification level (ie. if you have OW and AOW, just enter AOW)
Tenth Participant's Name

First Name*

Middle Name

Last Name*

Phone*
Tenth Participant's Date of Birth*
Tenth Participant's Diving Certification Level

Please add your highest certification level (ie. if you have OW and AOW, just enter AOW)
Parent or Guardian's Email Address

Email*

Confirm Email*
Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone Number*
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*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Diving Certification Level

Please add your highest certification level (ie. if you have OW and AOW, just enter AOW)
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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