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BOAT TRAVEL AND SCUBA DIVING

Liability Release & Assumption of Risk

Please read carefully before signing.

Non-Agency Disclosure and Acknowledgment Agreement

I understand and agree that PADI Members ("Members"), including Divers West Inc. and/or any individual PADI Instructors and Divemasters associated with the program in which I am participating, are licensed to use various PADI Trademarks and to conduct PADI training, but are not agents, employees or franchisees of PADI Americas, Inc, or its parent, subsidiary and affiliated corporations ("PADI"). I further understand that Member business activities are independent, and are neither owned nor operated by PADI, and that while PADI establishes the standards for PADI diver training programs, it is not responsible for, nor does it have the right to control, the operation of the Members' business activities and the day-to-day conduct of PADI programs and supervision of divers by the Members or their associated staff. I further understand and agree on behalf of myself, my heirs and my estate that in the event of an injury or death during this activity, neither I nor my estate shall seek to hold PADI Iiable for the actions, inactions or negligence of Divers West Inc., and/or the instructors and divemasters associated with the activity.

Liability Release and Assumption of Risk Agreement

I hereby affirm that I am a certified and competent 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"). This release/agreement will be effective for the Boat Trip Date and thereafter.

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 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 certified diver, a student diver in a diving class, or passenger.

I understand and agree that neither the dive professional(s); nor the crew or owner of the vessel; nor the vessel itself; 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 Released 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 Released Parties responsible for the same.

I am aware that safe dive practices suggest diving with a buddy unless trained as a self-reliant diver. Accordingly, it is my responsibility to plan my dive allowing for my diving experience and 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, and follow the instructions and dive briefing of the dive professional(s)/vessel crew. I affirm it is my responsibility to inspect all of my equipment prior to the Excursion and that I should not dive if my equipment is not functioning properly. I will not hold the Released Parties responsible for my failure to inspect my equipment prior to diving or if I choose to dive with equipment that may not be functioning properly.

I further state that I am of lawful age and legally competent to sign this Agreement, 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 may have to sue the Released 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 Released 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 NON-AGENCY DISCLOSURE AND ACKNOWLEDGMENT AGREEMENT AND LIABILITY RELEASE AND ASSUMPTION OF RISK AGREEMENT BY READING BOTH BEFORE I SIGNED BELOW ON BEHALF OF MYSELF AND MY HEIRS.

Today's Date: July 3, 2020

First Diver/Passenger Name

First Name*

Last Name*

Phone*
First Diver/Passenger Date of Birth*
First Diver/Passenger Information
Diver Accident Insurance?*
No
Yes

Policy Number

Boat Trip Date *
First Diver/Passenger Signature*
Second Diver/Passenger Name

First Name*

Last Name*
Second Diver/Passenger Date of Birth*
Second Diver/Passenger Information
Diver Accident Insurance?*
No
Yes

Policy Number

Boat Trip Date *
Third Diver/Passenger Name

First Name*

Last Name*
Third Diver/Passenger Date of Birth*
Third Diver/Passenger Information
Diver Accident Insurance?*
No
Yes

Policy Number

Boat Trip Date *
Fourth Diver/Passenger Name

First Name*

Last Name*
Fourth Diver/Passenger Date of Birth*
Fourth Diver/Passenger Information
Diver Accident Insurance?*
No
Yes

Policy Number

Boat Trip Date *
Fifth Diver/Passenger Name

First Name*

Last Name*
Fifth Diver/Passenger Date of Birth*
Fifth Diver/Passenger Information
Diver Accident Insurance?*
No
Yes

Policy Number

Boat Trip Date *
Sixth Diver/Passenger Name

First Name*

Last Name*
Sixth Diver/Passenger Date of Birth*
Sixth Diver/Passenger Information
Diver Accident Insurance?*
No
Yes

Policy Number

Boat Trip Date *
Seventh Diver/Passenger Name

First Name*

Last Name*
Seventh Diver/Passenger Date of Birth*
Seventh Diver/Passenger Information
Diver Accident Insurance?*
No
Yes

Policy Number

Boat Trip Date *
Eighth Diver/Passenger Name

First Name*

Last Name*
Eighth Diver/Passenger Date of Birth*
Eighth Diver/Passenger Information
Diver Accident Insurance?*
No
Yes

Policy Number

Boat Trip Date *
Ninth Diver/Passenger Name

First Name*

Last Name*
Ninth Diver/Passenger Date of Birth*
Ninth Diver/Passenger Information
Diver Accident Insurance?*
No
Yes

Policy Number

Boat Trip Date *
Tenth Diver/Passenger Name

First Name*

Last Name*
Tenth Diver/Passenger Date of Birth*
Tenth Diver/Passenger Information
Diver Accident Insurance?*
No
Yes

Policy Number

Boat Trip Date *
Diver/Passenger Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:*
City:*
State/Province:*
Zip/Postal:*
Parent or Guardian's Email Address

Email*

Confirm Email*
Check to receive information, news, and discounts by e-mail.
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*

Last Name*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Information
Diver Accident Insurance?*
No
Yes

Policy Number

Boat Trip Date *
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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