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Youth Diving: Responsibility and Risks Acknowledgment

(Please read carefully, fill in all blanks, and sign and date below.)

I/we and my/our child have viewed and understand the Youth Diving: Responsibility and Risks video or flip chart. We affirm we have been advised and thoroughly informed that diving is an adventure sport with inherent risks to the participant. These risks may include, but are not limited to, pressure related injuries affecting the lungs, sinuses and ears, drowning, panic and other serious injury or death. We also understand our responsi- bilities, as parent and participant (child), in participating in scuba activities and agree to accept those responsibilities.

As the parent/guardian of the minor child, I/we understand and agree it is solely my/our responsibility
to evaluate whether my/our child should participate in scuba activities. Our decision is based upon our knowledge of the mental, physical and emotional abilities of our child, as well as his/her medical history. I/we understand and agree it is my/our responsibility to discuss with a physician any questions I/we have regarding my/our child’s medical history and participation in this activity.

I/we understand and agree that it is my/our responsibility to continue to monitor the abilities and health of my/our child to determine whether he/she should continue in this program and continue to dive after the program.

I/we agree to abide by all supervisory and depth limitations that may accompany my/our child’s PADI certification.

I/we understand that PADI certifies instructors/dive centers and provides materials for programs devel- oped by PADI.

I/we understand that the dive center/resort and the instructor are responsible for the conduct and super- vision of this activity

I/we understand my responsibilities and those of my child as set forth in the Youth Diving Responsibili- ties and Risk video or flip chart.

I/we have read this Acknowledgment, understand and agree to the terms and conditions, and understand and agree that this Acknowledgment is a binding contract between us, the dive professional, the dive facility and PADI.

Today's Date: October 29, 2024

First Parent or Legal Guardian's Name

First Name*

Last Name*
First Parent or Legal Guardian's Age Acknowledgment*
First Parent or Legal Guardian's Date of Birth*
I certify that I am 18 years of age or older
First Parent or Legal Guardian's Signature*
Second Parent or Legal Guardian's Name

First Name*

Last Name*
Second Parent or Legal Guardian's Date of Birth*
Third Parent or Legal Guardian's Name

First Name*

Last Name*
Third Parent or Legal Guardian's Date of Birth*
Fourth Parent or Legal Guardian's Name

First Name*

Last Name*
Fourth Parent or Legal Guardian's Date of Birth*
Fifth Parent or Legal Guardian's Name

First Name*

Last Name*
Fifth Parent or Legal Guardian's Date of Birth*
Sixth Parent or Legal Guardian's Name

First Name*

Last Name*
Sixth Parent or Legal Guardian's Date of Birth*
Seventh Parent or Legal Guardian's Name

First Name*

Last Name*
Seventh Parent or Legal Guardian's Date of Birth*
Eighth Parent or Legal Guardian's Name

First Name*

Last Name*
Eighth Parent or Legal Guardian's Date of Birth*
Ninth Parent or Legal Guardian's Name

First Name*

Last Name*
Ninth Parent or Legal Guardian's Date of Birth*
Tenth Parent or Legal Guardian's Name

First Name*

Last Name*
Tenth Parent or Legal Guardian's Date of Birth*
Parent or Guardian's Email Address

Email
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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.


By signing below the parent or court-appointed legal guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Last Name*

Phone*
Parent or Guardian's Age Acknowledgment*
Parent or Guardian's Date of Birth*
I certify that I am 18 years of age or older
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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