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MAMMOTH LAKE DIVE PARK

ANNUAL

Release of Liability/Assumption of Risk/Non-agency Acknowledgement Form

FOR SCUBA STUDENTS

**Once you obtain your Scuba certification, you will need to fill out another waiver to return to the park as a Certified diver, then on an annual basis thereafter**

Please read carefully and fill in all blanks before signing.

Liability Release and Assumption of Risk Agreement

I, hereby declare that I am a certified diver trained in safe dive practices, or a student diver under the control and supervision of a certified instructor, and affirm that I am aware that swimming, skin diving, freediving and scuba diving (hereinafter “aquatic activities”) have inherent risks which may result in serious injury or death. I understand these hazards include, but are not limited to, air expansion injuries, drowning, decompression sickness, slipping or falling, and injuries occurring while getting in or out of the water. By signing this release, I certify that I am fully aware of and expressly assume these and all other risks involved in participating in such aquatic activities, whether conducted as a recreational activity or part of a class.

I UNDERSTAND THAT THERE IS NEVER A LIFE GUARD ON DUTY AT THE MAMMOTH LAKE RECREATIONAL PARK, LLC.

I understand and agree that neither Mammoth Lake Recreational Park, LLC, nor the owners, officers, employees, agents, or assigns of Mammoth Lake Recreational Park, LLC, nor any of its subsidiary or affiliated corporations (hereinafter “Released Parties”) may be held liable or responsible in any way for any injury, death or other damages to my, my family, estate, heirs or assigns that may occur as a result of my participation in aquatic activities at this facility or as the result of the negligence of any party, including the Released Parties, whether passive or active.

I further understand that Mammoth Lake Recreatoional Park, LLC (hereinafter “Lake”) is a man- made lake developed for aquatic activities including but not limited to swimming, skin diving, freediving and scuba diving. I understand that water conditions such as visibility may change and may be affected by silting and other causes. I further acknowledge that there may be structures in the Lake that may create obstacles such as overhead environments. I affirm I will not hold the Released Parties responsible if I am injured as a result of any such structures or changes in water conditions while I am participating in aquatic activities in the Lake.

I further state that I am of lawful age and legally competent to sign this Liability Release and Assumption of Risk 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 is 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 that my heirs, assigns, or beneficiaries will be estopped from claiming otherwise because of my representations to the Released Parties.

I, by this Agreement, do hereby exempt and release Mammoth Lake Recreational Park, LLC, PADI Americas, Inc., and all related entities as defined above from all liability and responsibility whatsoever for personal injury, property damage or wrongful death, however caused, including but not limited to 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 signing on behalf of myself and my heirs.

Dated: September 18, 2020 

First Student Name

First Name*

Last Name*

Phone*
First Student Date of Birth*
First Student Certification

Enter the school/organization with which you are obtaining your certification: *
First Student Signature*
Second Student Name

First Name*

Last Name*
Second Student Date of Birth*
Second Student Certification

Enter the school/organization with which you are obtaining your certification: *
Third Student Name

First Name*

Last Name*
Third Student Date of Birth*
Third Student Certification

Enter the school/organization with which you are obtaining your certification: *
Fourth Student Name

First Name*

Last Name*
Fourth Student Date of Birth*
Fourth Student Certification

Enter the school/organization with which you are obtaining your certification: *
Fifth Student Name

First Name*

Last Name*
Fifth Student Date of Birth*
Fifth Student Certification

Enter the school/organization with which you are obtaining your certification: *
Sixth Student Name

First Name*

Last Name*
Sixth Student Date of Birth*
Sixth Student Certification

Enter the school/organization with which you are obtaining your certification: *
Seventh Student Name

First Name*

Last Name*
Seventh Student Date of Birth*
Seventh Student Certification

Enter the school/organization with which you are obtaining your certification: *
Eighth Student Name

First Name*

Last Name*
Eighth Student Date of Birth*
Eighth Student Certification

Enter the school/organization with which you are obtaining your certification: *
Ninth Student Name

First Name*

Last Name*
Ninth Student Date of Birth*
Ninth Student Certification

Enter the school/organization with which you are obtaining your certification: *
Tenth Student Name

First Name*

Last Name*
Tenth Student Date of Birth*
Tenth Student Certification

Enter the school/organization with which you are obtaining your certification: *
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 Certification

Enter the school/organization with which you are obtaining your certification: *
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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