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BLU3, Inc.

BLU3 Guided Tours - Nemo

IMPORTANT – READ CAREFULLY – THIS AGREEMENT AFFECTS YOUR LEGAL RIGHTS! 

Surface Supplied Air diving with Nemo and BLU3 products is a fun and exciting way to explore the shallow depths of the underwater world. As with any underwater adventure there are inherent risks that may results in serious illness, injury or death. 

On this guided tour, you will be supervised by a BLU3 Dive Guide. It is your responsibility to follow the rules set forth in these documents and to comply with the instructions of your BLU3 Dive Guide. 

We hope you have an enjoyable Nemo experience. In order to do so, please read the following sections carefully. Pay close attention to any accompanying training materials and follow the instructions of your BLU3 Dive Guide throughout your guided tour. Have fun!

NOTICE: THIS IS A LEGALLY BINDING AGREEMENT. READ THIS CAREFULLY BEFORE SIGNING. PLEASE FEEL FREE TO CONSULT WITH LEGAL COUNSEL OF YOUR CHOICE BEFORE COMPLETING THIS AGREEMENT.  

Nemo Fitness-to-dive Evaluation

Surface Supplied Air (referred to as SSA such as BLU3/Nemo equipment) divers need to be in good health to dive. If you have any questions about your medical, mental or physical fitness to dive, you should consult a physician to assess your individual risks factors. 

This evaluation is to help you determine if you should be examined by a physician prior to diving. If you have any doubt about your fitness to dive, then you must obtain approval to dive from a physician. Failure to obtain a physician’s approval to dive may significantly increase your risk of illness, injury or death. You are solely responsible for honestly evaluating your fitness to dive and you are ultimately responsible for your safety and wellbeing when swimming and diving. 

Read each question below about your past and present medical history. If you are not sure of the correct answer, then answer “YES”. A “YES” response indicates an increased risk factor that must be evaluated by a physician. If any of these conditions apply to you, then you must obtain approval to dive from a physician before SSA diving with BLU3/Nemo equipment. The next section of this form requires you to fill in the answers to these fitness-to-dive questions.

  • Are you currently being treated or under the care of a medical professional for a medical, mental or physical condition? 
  • Do you take a prescription medication (not including birth control)?
  • Do you have or have you ever been treated for a heart, circulatory, blood, blood pressure, or bleeding abnormality?
  • Do you have or have you ever been treated for a stroke, seizure, head injury, loss of consciousness, migraines, behavioral or
    neurologic condition?
  • Do you have or have you ever been treated for an ear, sinus, mouth, throat or lung disorder – including asthma?
  • Do you have or have you ever been treated for diabetes, severe allergies, obesity, stomach or intestinal disorders?
  • Do you have or have you ever been treated for musculoskeletal, strength, stamina or mobility disorders?
  • Do you have any type of medical implant that could be affected by immersion in water or change in ambient pressure?
  • Do you have a pacemaker or medical implant that may be affected by magnets? Nemo has strong magnets and therefore must not be used by persons with pacemakers or medical implants that may be affected by magnets.

If you answered YES to any of these conditions, then you must be evaluated by a physician to approve your fitness to dive. You are responsible to obtain and keep a written document from the physician stating you are fit to dive. Documents for your physician to fill out are available at http://diveblu3.com/fitness-to-dive-evaluation. You can also ask your BLU3 Dive Guide or the business Operator to provide you with the forms. A copy of the form stating your physician’s approval to dive must be provided to the dive operator before any in-water Nemo activities may take place.

Additionally, if you are under the influence of alcohol or recreational drugs, unable to swim, prone to panic attacks, unable to exercise good judgment or you are unable to be responsible for you own safety and wellbeing, then you have a significant increase to risks of illness, injury and death while in the water and you should unconditionally refrain from swimming or diving.

Assumption of Risk, Waiver, Liability Release, and Hold Harmless Agreement

SSA diving has inherent risks that may cause serious injury, illness or death. Each Nemo diver assumes these inherent risks regardless of experience, age or environment just as swimmers and scuba divers assume these risks in supervised and unsupervised settings, at pools, open water, around watercraft and other water hazards. In consideration of using BLU3/Nemo equipment the PARTICIPANT expressly agrees to the terms and conditions of this Assumption of Risk Liability Release, Waiver and Hold Harmless Agreement, (herein referred to as AGREEMENT).

“PARTICIPANT” shall refer collectively to the following: each participant in a BLU3/Nemo guided tour, each individual owner of BLU3/Nemo equipment, each individual user of BLU3/Nemo equipment, and any person who suffers loss in the form of property damage, illness, injury, or death, including but not limited to family, heirs, assigns, entities or anyone who may have a claim, cause of action, legal right or other remedy as a consequence of property damage, illness, injury or death as a result of using BLU3/Nemo equipment and/or participating in a BLU3/Nemo guided tour.

“RELEASED PARTIES” shall refer collectively to the following: BLU3 Guided Tour Operator, BLU3, Inc., Brownies Marine Group, Inc., including but not limited to their respective manufacturers, assemblers, distributors, retailers, service centers, owners, employees, representatives, agents, independent contractors, affiliates, consultants, investors, insurers, assigns, successors, and any other person or entity that may be liable to PARTICIPANT for property damage, illness, injury or death as a result of BLU3/Nemo equipment.

VOLUNTARY PARTICIPATION & INFORMED CONSENT: PARTICIPANT voluntarily and with informed consent chooses to participate in activities including Nemo guided tours using BLU3/Nemo equipment, with the expressed understanding and assumption of the inherent risks of property damage, illness, injury and death associated with such activities.  

I Agree

PARTICIPANT EXCLUSIVELY BEARS THE FOLLOWING RESPONSIBILITIES:

  • PARTICIPANT is responsible for their safety and wellbeing at all times while using BLU3/Nemo equipment.
  • PARTICIPANT is responsible for having completed the Nemo Guided Tour Training Video and Nemo Guided Tour Assumption of Risk, Liability Release and Hold Harmless Agreement.
  • PARTICIPANT is responsible for being medically, mentally and physically fit to dive using Nemo. See the Nemo Fitness-to-dive Evaluation at diveblu3.com/fitness-to-dive-evaluation. 
  • PARTICIPANT is responsible for remaining within 3M/10ft of the Dive Guide at all times during Nemo guided tour.
  • PARTICIPANT is responsible for properly checking their buoyancy in accordance with instructions in the Nemo Guided Tour Training Video. 
  • PARTICIPANT responsible for using appropriate ascent procedures to avoid lung overexpansion injuries in accordance with instructions in the Nemo Guided Tour Training Video.
  • PARTICIPANT is responsible to ensure each Nemo diver only uses the BLU3/Nemo equipment as designed and expressly intended.
  • PARTICIPANT shall be exclusively responsible and liable for any injuries and damages caused by BLU3/Nemo equipment.

I Agree

ASSUMPTION OF RISK: Each PARTICIPANT using Nemo/BLU3 equipment expressly assumes full and complete risk of property damage, illness, injury and death as a result of use of RELEASED PARTIES equipment, failure to warn, inadequate instructions and/or supervision during Nemo Guided Tour activities. 

I Agree

WAIVER & RELEASE OF LIABILITY: PARTICIPANT expressly WAIVES and RELEASES the RELEASED PARTIES of all liability and responsibility whatsoever resulting in property damage, illness, injury or death due to negligence, including negligence by the RELEASED PARTIES, whether the negligent act(s) were passive or active, direct or indirect, to the fullest extent allowed by law, even if WAIVING and RELEASING the RELEASED PARTIES is socially unacceptable or generally against public expectations. By signing this AGREEMENT, the PARTICIPANT expressly, completely and unconditionally agrees not to sue the RELEASED PARTIES for negligence resulting in property damage, illness, injury or death. 

I Agree

HOLD HARMLESS & INDEMNIFICATION: PARTICIPANT agrees to HOLD HARMLESS and INDEMNIFY the RELEASED PARTIES from all claims, causes of action or lawsuits, arising from use of BLU3/Nemo equipment, including but not limited to the Nemo surface supplied air diving systems. This AGREEMENT obligates PARTICIPANT to pay all costs to investigate, defend, pay judgments, court costs, attorneys’ fees, etcetera incurred by RELEASED PARTIES to enforce the AGREEMENT.

I Agree

LEGAL CONTRACT, GOVERNING LAW & SEVERABILITY: PARTICIPANT understands this AGREEMENT is a contract giving up legal rights. This AGREEMENT shall be in full legal force from the date signed into the future until all claims and legal action against the RELEASED PARTIES have been fully resolved. All legal actions arising as a result of this AGREEMENT shall be governed by the Laws of the State of Florida and the exclusive venue and jurisdiction of any legal action shall be Broward County, Florida. If any portion of this AGREEMENT is found to be unenforceable or invalid, then that portion shall be severed and the remainder shall continue in full legal force. Any digital completion, signature, confirmation or electronic format of this AGREEMENT shall have full legal force as if it was an original signed document. The PARTICIPANT voluntarily enter into this AGREEMENT based exclusively on the preprinted terms of the AGREEMENT without modification or relying on any other representations or assurances.

I Agree

PARTICIPANT has fully read, understands and agrees to be legally bound by this AGREEMENT. PARTICIPANT is at least 18 years old and competent to engage in this AGREEMENT or PARTICIPANT will be signed for by a Parent or Guardian. By signing this AGREEMENT, PARTICIPANT is giving up legal rights for myself and all others who may have a claim, on my or their behalf, against the RELEASED PARTIES as a result of property damage, illness, injury or death caused by Nemo/BLU3 equipment. 

I Agree

RELEASE FOR MINORS (UNDER 18 YEARS OF AGE)

NOTICE TO THE MINOR CHILD’S NATURAL GUARDIAN / PARENT
READ THIS FORM COMPLETELY AND CAREFULLY. YOU ARE AGREEING TO LET YOUR MINOR CHILD ENGAGE IN A POTENTIALLY DANGEROUS ACTIVITY. YOU ARE AGREEING THAT, EVEN IF BLU3 Guided Tour Operator, BLU3, Inc., Brownies Marine Group, Inc.
(RELEASED PARTIES) USES REASONABLE CARE IN PROVIDING THIS ACTIVITY, THERE IS A CHANCE YOUR CHILD MAY BE SERIOUSLY INJURED OR KILLED BY PARTICIPATING IN THIS ACTIVITY BECAUSE THERE ARE CERTAIN DANGERS INHERENT IN THE ACTIVITY WHICH CANNOT BE AVOIDED OR ELIMINATED. BY SIGNING THIS FORM YOU ARE GIVING UP YOUR CHILD’S RIGHT AND YOUR RIGHT TO RECOVER FROM THE RELEASED PARTIES IN A LAWSUIT FOR ANY PERSONAL INJURY, INCLUDING DEATH, TO YOUR CHILD OR ANY PROPERTY DAMAGE THAT RESULTS FROM THE RISKS THAT ARE A NATURAL PART OF THE ACTIVITY. YOU HAVE THE RIGHT TO REFUSE TO SIGN THIS FORM, AND THE RELEASED PARTIES HAVE THE RIGHT TO REFUSE TO LET YOUR CHILD PARTICIPATE IF YOU DO NOT SIGN THIS FORM.

If Participant is a Minor, by my signature, I release all claims that both they and I have for all activities with RELEASED PARTIES. 

Today's Date: June 28, 2022

First Participant's Name

First Name*

Middle Name

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Information
Are you currently being treated or under the care of a medical professional for a medical, mental or physical condition?*
No
Yes (If this is your answer, you need to seek physician approval prior to diving)
Do you take a prescription medication (not including birth control)?*
No
Yes (If this is your answer, you need to seek physician approval prior to diving)
Do you have or have you ever been treated for a heart, circulatory, blood, blood pressure, or bleeding abnormality?*
No
Yes (If this is your answer, you need to seek physician approval prior to diving)
Do you have or have you ever been treated for a stroke, seizure, head injury, loss of consciousness, migraines, behavioral or neurologic condition?*
No
Yes (If this is your answer, you need to seek physician approval prior to diving)
Do you have or have you ever been treated for an ear, sinus, mouth, throat or lung disorder - including asthma?*
No
Yes (If this is your answer, you need to seek physician approval prior to diving)
Do you have or have you ever been treated for diabetes, severe allergies, obesity, stomach or intestinal disorders?*
No
Yes (If this is your answer, you need to seek physician approval prior to diving)
Do you have or have you ever been treated for musculoskeletal, strength, stamina or mobility disorders?*
No
Yes (If this is your answer, you need to seek physician approval prior to diving)
Do you have any type of medical implant that could be affected by immersion in water or change in ambient pressure?*
No
Yes (If this is your answer, you need to seek physician approval prior to diving)
Do you have a pacemaker or medical implant that may be affected by magnets? Nemo has strong magnets and therefore must not be used by persons with pacemakers or medical implants that may be affected by magnets.*
No
Yes (If this is your answer, then you must not participate in Nemo diving. Stay at least 2 feet away from Nemo at all times.)
First Participant's Signature*
Second Participant's Name

First Name*

Middle Name

Last Name*
Second Participant's Date of Birth*
Second Participant's Information
Are you currently being treated or under the care of a medical professional for a medical, mental or physical condition?*
No
Yes (If this is your answer, you need to seek physician approval prior to diving)
Do you take a prescription medication (not including birth control)?*
No
Yes (If this is your answer, you need to seek physician approval prior to diving)
Do you have or have you ever been treated for a heart, circulatory, blood, blood pressure, or bleeding abnormality?*
No
Yes (If this is your answer, you need to seek physician approval prior to diving)
Do you have or have you ever been treated for a stroke, seizure, head injury, loss of consciousness, migraines, behavioral or neurologic condition?*
No
Yes (If this is your answer, you need to seek physician approval prior to diving)
Do you have or have you ever been treated for an ear, sinus, mouth, throat or lung disorder - including asthma?*
No
Yes (If this is your answer, you need to seek physician approval prior to diving)
Do you have or have you ever been treated for diabetes, severe allergies, obesity, stomach or intestinal disorders?*
No
Yes (If this is your answer, you need to seek physician approval prior to diving)
Do you have or have you ever been treated for musculoskeletal, strength, stamina or mobility disorders?*
No
Yes (If this is your answer, you need to seek physician approval prior to diving)
Do you have any type of medical implant that could be affected by immersion in water or change in ambient pressure?*
No
Yes (If this is your answer, you need to seek physician approval prior to diving)
Do you have a pacemaker or medical implant that may be affected by magnets? Nemo has strong magnets and therefore must not be used by persons with pacemakers or medical implants that may be affected by magnets.*
No
Yes (If this is your answer, then you must not participate in Nemo diving. Stay at least 2 feet away from Nemo at all times.)
Third Participant's Name

First Name*

Middle Name

Last Name*
Third Participant's Date of Birth*
Third Participant's Information
Are you currently being treated or under the care of a medical professional for a medical, mental or physical condition?*
No
Yes (If this is your answer, you need to seek physician approval prior to diving)
Do you take a prescription medication (not including birth control)?*
No
Yes (If this is your answer, you need to seek physician approval prior to diving)
Do you have or have you ever been treated for a heart, circulatory, blood, blood pressure, or bleeding abnormality?*
No
Yes (If this is your answer, you need to seek physician approval prior to diving)
Do you have or have you ever been treated for a stroke, seizure, head injury, loss of consciousness, migraines, behavioral or neurologic condition?*
No
Yes (If this is your answer, you need to seek physician approval prior to diving)
Do you have or have you ever been treated for an ear, sinus, mouth, throat or lung disorder - including asthma?*
No
Yes (If this is your answer, you need to seek physician approval prior to diving)
Do you have or have you ever been treated for diabetes, severe allergies, obesity, stomach or intestinal disorders?*
No
Yes (If this is your answer, you need to seek physician approval prior to diving)
Do you have or have you ever been treated for musculoskeletal, strength, stamina or mobility disorders?*
No
Yes (If this is your answer, you need to seek physician approval prior to diving)
Do you have any type of medical implant that could be affected by immersion in water or change in ambient pressure?*
No
Yes (If this is your answer, you need to seek physician approval prior to diving)
Do you have a pacemaker or medical implant that may be affected by magnets? Nemo has strong magnets and therefore must not be used by persons with pacemakers or medical implants that may be affected by magnets.*
No
Yes (If this is your answer, then you must not participate in Nemo diving. Stay at least 2 feet away from Nemo at all times.)
Fourth Participant's Name

First Name*

Middle Name

Last Name*
Fourth Participant's Date of Birth*
Fourth Participant's Information
Are you currently being treated or under the care of a medical professional for a medical, mental or physical condition?*
No
Yes (If this is your answer, you need to seek physician approval prior to diving)
Do you take a prescription medication (not including birth control)?*
No
Yes (If this is your answer, you need to seek physician approval prior to diving)
Do you have or have you ever been treated for a heart, circulatory, blood, blood pressure, or bleeding abnormality?*
No
Yes (If this is your answer, you need to seek physician approval prior to diving)
Do you have or have you ever been treated for a stroke, seizure, head injury, loss of consciousness, migraines, behavioral or neurologic condition?*
No
Yes (If this is your answer, you need to seek physician approval prior to diving)
Do you have or have you ever been treated for an ear, sinus, mouth, throat or lung disorder - including asthma?*
No
Yes (If this is your answer, you need to seek physician approval prior to diving)
Do you have or have you ever been treated for diabetes, severe allergies, obesity, stomach or intestinal disorders?*
No
Yes (If this is your answer, you need to seek physician approval prior to diving)
Do you have or have you ever been treated for musculoskeletal, strength, stamina or mobility disorders?*
No
Yes (If this is your answer, you need to seek physician approval prior to diving)
Do you have any type of medical implant that could be affected by immersion in water or change in ambient pressure?*
No
Yes (If this is your answer, you need to seek physician approval prior to diving)
Do you have a pacemaker or medical implant that may be affected by magnets? Nemo has strong magnets and therefore must not be used by persons with pacemakers or medical implants that may be affected by magnets.*
No
Yes (If this is your answer, then you must not participate in Nemo diving. Stay at least 2 feet away from Nemo at all times.)
Fifth Participant's Name

First Name*

Middle Name

Last Name*
Fifth Participant's Date of Birth*
Fifth Participant's Information
Are you currently being treated or under the care of a medical professional for a medical, mental or physical condition?*
No
Yes (If this is your answer, you need to seek physician approval prior to diving)
Do you take a prescription medication (not including birth control)?*
No
Yes (If this is your answer, you need to seek physician approval prior to diving)
Do you have or have you ever been treated for a heart, circulatory, blood, blood pressure, or bleeding abnormality?*
No
Yes (If this is your answer, you need to seek physician approval prior to diving)
Do you have or have you ever been treated for a stroke, seizure, head injury, loss of consciousness, migraines, behavioral or neurologic condition?*
No
Yes (If this is your answer, you need to seek physician approval prior to diving)
Do you have or have you ever been treated for an ear, sinus, mouth, throat or lung disorder - including asthma?*
No
Yes (If this is your answer, you need to seek physician approval prior to diving)
Do you have or have you ever been treated for diabetes, severe allergies, obesity, stomach or intestinal disorders?*
No
Yes (If this is your answer, you need to seek physician approval prior to diving)
Do you have or have you ever been treated for musculoskeletal, strength, stamina or mobility disorders?*
No
Yes (If this is your answer, you need to seek physician approval prior to diving)
Do you have any type of medical implant that could be affected by immersion in water or change in ambient pressure?*
No
Yes (If this is your answer, you need to seek physician approval prior to diving)
Do you have a pacemaker or medical implant that may be affected by magnets? Nemo has strong magnets and therefore must not be used by persons with pacemakers or medical implants that may be affected by magnets.*
No
Yes (If this is your answer, then you must not participate in Nemo diving. Stay at least 2 feet away from Nemo at all times.)
Sixth Participant's Name

First Name*

Middle Name

Last Name*
Sixth Participant's Date of Birth*
Sixth Participant's Information
Are you currently being treated or under the care of a medical professional for a medical, mental or physical condition?*
No
Yes (If this is your answer, you need to seek physician approval prior to diving)
Do you take a prescription medication (not including birth control)?*
No
Yes (If this is your answer, you need to seek physician approval prior to diving)
Do you have or have you ever been treated for a heart, circulatory, blood, blood pressure, or bleeding abnormality?*
No
Yes (If this is your answer, you need to seek physician approval prior to diving)
Do you have or have you ever been treated for a stroke, seizure, head injury, loss of consciousness, migraines, behavioral or neurologic condition?*
No
Yes (If this is your answer, you need to seek physician approval prior to diving)
Do you have or have you ever been treated for an ear, sinus, mouth, throat or lung disorder - including asthma?*
No
Yes (If this is your answer, you need to seek physician approval prior to diving)
Do you have or have you ever been treated for diabetes, severe allergies, obesity, stomach or intestinal disorders?*
No
Yes (If this is your answer, you need to seek physician approval prior to diving)
Do you have or have you ever been treated for musculoskeletal, strength, stamina or mobility disorders?*
No
Yes (If this is your answer, you need to seek physician approval prior to diving)
Do you have any type of medical implant that could be affected by immersion in water or change in ambient pressure?*
No
Yes (If this is your answer, you need to seek physician approval prior to diving)
Do you have a pacemaker or medical implant that may be affected by magnets? Nemo has strong magnets and therefore must not be used by persons with pacemakers or medical implants that may be affected by magnets.*
No
Yes (If this is your answer, then you must not participate in Nemo diving. Stay at least 2 feet away from Nemo at all times.)
Seventh Participant's Name

First Name*

Middle Name

Last Name*
Seventh Participant's Date of Birth*
Seventh Participant's Information
Are you currently being treated or under the care of a medical professional for a medical, mental or physical condition?*
No
Yes (If this is your answer, you need to seek physician approval prior to diving)
Do you take a prescription medication (not including birth control)?*
No
Yes (If this is your answer, you need to seek physician approval prior to diving)
Do you have or have you ever been treated for a heart, circulatory, blood, blood pressure, or bleeding abnormality?*
No
Yes (If this is your answer, you need to seek physician approval prior to diving)
Do you have or have you ever been treated for a stroke, seizure, head injury, loss of consciousness, migraines, behavioral or neurologic condition?*
No
Yes (If this is your answer, you need to seek physician approval prior to diving)
Do you have or have you ever been treated for an ear, sinus, mouth, throat or lung disorder - including asthma?*
No
Yes (If this is your answer, you need to seek physician approval prior to diving)
Do you have or have you ever been treated for diabetes, severe allergies, obesity, stomach or intestinal disorders?*
No
Yes (If this is your answer, you need to seek physician approval prior to diving)
Do you have or have you ever been treated for musculoskeletal, strength, stamina or mobility disorders?*
No
Yes (If this is your answer, you need to seek physician approval prior to diving)
Do you have any type of medical implant that could be affected by immersion in water or change in ambient pressure?*
No
Yes (If this is your answer, you need to seek physician approval prior to diving)
Do you have a pacemaker or medical implant that may be affected by magnets? Nemo has strong magnets and therefore must not be used by persons with pacemakers or medical implants that may be affected by magnets.*
No
Yes (If this is your answer, then you must not participate in Nemo diving. Stay at least 2 feet away from Nemo at all times.)
Eighth Participant's Name

First Name*

Middle Name

Last Name*
Eighth Participant's Date of Birth*
Eighth Participant's Information
Are you currently being treated or under the care of a medical professional for a medical, mental or physical condition?*
No
Yes (If this is your answer, you need to seek physician approval prior to diving)
Do you take a prescription medication (not including birth control)?*
No
Yes (If this is your answer, you need to seek physician approval prior to diving)
Do you have or have you ever been treated for a heart, circulatory, blood, blood pressure, or bleeding abnormality?*
No
Yes (If this is your answer, you need to seek physician approval prior to diving)
Do you have or have you ever been treated for a stroke, seizure, head injury, loss of consciousness, migraines, behavioral or neurologic condition?*
No
Yes (If this is your answer, you need to seek physician approval prior to diving)
Do you have or have you ever been treated for an ear, sinus, mouth, throat or lung disorder - including asthma?*
No
Yes (If this is your answer, you need to seek physician approval prior to diving)
Do you have or have you ever been treated for diabetes, severe allergies, obesity, stomach or intestinal disorders?*
No
Yes (If this is your answer, you need to seek physician approval prior to diving)
Do you have or have you ever been treated for musculoskeletal, strength, stamina or mobility disorders?*
No
Yes (If this is your answer, you need to seek physician approval prior to diving)
Do you have any type of medical implant that could be affected by immersion in water or change in ambient pressure?*
No
Yes (If this is your answer, you need to seek physician approval prior to diving)
Do you have a pacemaker or medical implant that may be affected by magnets? Nemo has strong magnets and therefore must not be used by persons with pacemakers or medical implants that may be affected by magnets.*
No
Yes (If this is your answer, then you must not participate in Nemo diving. Stay at least 2 feet away from Nemo at all times.)
Ninth Participant's Name

First Name*

Middle Name

Last Name*
Ninth Participant's Date of Birth*
Ninth Participant's Information
Are you currently being treated or under the care of a medical professional for a medical, mental or physical condition?*
No
Yes (If this is your answer, you need to seek physician approval prior to diving)
Do you take a prescription medication (not including birth control)?*
No
Yes (If this is your answer, you need to seek physician approval prior to diving)
Do you have or have you ever been treated for a heart, circulatory, blood, blood pressure, or bleeding abnormality?*
No
Yes (If this is your answer, you need to seek physician approval prior to diving)
Do you have or have you ever been treated for a stroke, seizure, head injury, loss of consciousness, migraines, behavioral or neurologic condition?*
No
Yes (If this is your answer, you need to seek physician approval prior to diving)
Do you have or have you ever been treated for an ear, sinus, mouth, throat or lung disorder - including asthma?*
No
Yes (If this is your answer, you need to seek physician approval prior to diving)
Do you have or have you ever been treated for diabetes, severe allergies, obesity, stomach or intestinal disorders?*
No
Yes (If this is your answer, you need to seek physician approval prior to diving)
Do you have or have you ever been treated for musculoskeletal, strength, stamina or mobility disorders?*
No
Yes (If this is your answer, you need to seek physician approval prior to diving)
Do you have any type of medical implant that could be affected by immersion in water or change in ambient pressure?*
No
Yes (If this is your answer, you need to seek physician approval prior to diving)
Do you have a pacemaker or medical implant that may be affected by magnets? Nemo has strong magnets and therefore must not be used by persons with pacemakers or medical implants that may be affected by magnets.*
No
Yes (If this is your answer, then you must not participate in Nemo diving. Stay at least 2 feet away from Nemo at all times.)
Tenth Participant's Name

First Name*

Middle Name

Last Name*
Tenth Participant's Date of Birth*
Tenth Participant's Information
Are you currently being treated or under the care of a medical professional for a medical, mental or physical condition?*
No
Yes (If this is your answer, you need to seek physician approval prior to diving)
Do you take a prescription medication (not including birth control)?*
No
Yes (If this is your answer, you need to seek physician approval prior to diving)
Do you have or have you ever been treated for a heart, circulatory, blood, blood pressure, or bleeding abnormality?*
No
Yes (If this is your answer, you need to seek physician approval prior to diving)
Do you have or have you ever been treated for a stroke, seizure, head injury, loss of consciousness, migraines, behavioral or neurologic condition?*
No
Yes (If this is your answer, you need to seek physician approval prior to diving)
Do you have or have you ever been treated for an ear, sinus, mouth, throat or lung disorder - including asthma?*
No
Yes (If this is your answer, you need to seek physician approval prior to diving)
Do you have or have you ever been treated for diabetes, severe allergies, obesity, stomach or intestinal disorders?*
No
Yes (If this is your answer, you need to seek physician approval prior to diving)
Do you have or have you ever been treated for musculoskeletal, strength, stamina or mobility disorders?*
No
Yes (If this is your answer, you need to seek physician approval prior to diving)
Do you have any type of medical implant that could be affected by immersion in water or change in ambient pressure?*
No
Yes (If this is your answer, you need to seek physician approval prior to diving)
Do you have a pacemaker or medical implant that may be affected by magnets? Nemo has strong magnets and therefore must not be used by persons with pacemakers or medical implants that may be affected by magnets.*
No
Yes (If this is your answer, then you must not participate in Nemo diving. Stay at least 2 feet away from Nemo at all times.)
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 or Guardian's Driver's License / ID Card

Driver's License / ID Card Number*

Issuing State*
Nemo Diving Location
Select the location you will be attending*
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. Minors must be at least 10 years of age to participate. NOTICE TO THE MINOR CHILD’S NATURAL GUARDIAN / PARENT READ THIS FORM COMPLETELY AND CAREFULLY. YOU ARE AGREEING TO LET YOUR MINOR CHILD ENGAGE IN A POTENTIALLY DANGEROUS ACTIVITY. YOU ARE AGREEING THAT, EVEN IF EACH OF THE MINORS LISTED ABOVE (RELEASED PARTIES) USES REASONABLE CARE IN PROVIDING THIS ACTIVITY, THERE IS A CHANCE YOUR CHILD MAY BE SERIOUSLY INJURED OR KILLED BY PARTICIPATING IN THIS ACTIVITY BECAUSE THERE ARE CERTAIN DANGERS INHERENT IN THE ACTIVITY WHICH CANNOT BE AVOIDED OR ELIMINATED. BY SIGNING THIS FORM YOU ARE GIVING UP YOUR CHILD’S RIGHT AND YOUR RIGHT TO RECOVER FROM THE RELEASED PARTIES IN A LAWSUIT FOR ANY PERSONAL INJURY, INCLUDING DEATH, TO YOUR CHILD OR ANY PROPERTY DAMAGE THAT RESULTS FROM THE RISKS THAT ARE A NATURAL PART OF THE ACTIVITY. YOU HAVE THE RIGHT TO REFUSE TO SIGN THIS FORM, AND THE RELEASED PARTIES HAVE THE RIGHT TO REFUSE TO LET YOUR CHILD PARTICIPATE IF YOU DO NOT SIGN THIS FORM. If Participant is a Minor, by my signature, I release all claims that both they and I have for all activities with RELEASED PARTIES.
Parent or Guardian's Name

First Name*

Middle Name

Last Name*

Relationship*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Information
Are you currently being treated or under the care of a medical professional for a medical, mental or physical condition?*
No
Yes (If this is your answer, you need to seek physician approval prior to diving)
Do you take a prescription medication (not including birth control)?*
No
Yes (If this is your answer, you need to seek physician approval prior to diving)
Do you have or have you ever been treated for a heart, circulatory, blood, blood pressure, or bleeding abnormality?*
No
Yes (If this is your answer, you need to seek physician approval prior to diving)
Do you have or have you ever been treated for a stroke, seizure, head injury, loss of consciousness, migraines, behavioral or neurologic condition?*
No
Yes (If this is your answer, you need to seek physician approval prior to diving)
Do you have or have you ever been treated for an ear, sinus, mouth, throat or lung disorder - including asthma?*
No
Yes (If this is your answer, you need to seek physician approval prior to diving)
Do you have or have you ever been treated for diabetes, severe allergies, obesity, stomach or intestinal disorders?*
No
Yes (If this is your answer, you need to seek physician approval prior to diving)
Do you have or have you ever been treated for musculoskeletal, strength, stamina or mobility disorders?*
No
Yes (If this is your answer, you need to seek physician approval prior to diving)
Do you have any type of medical implant that could be affected by immersion in water or change in ambient pressure?*
No
Yes (If this is your answer, you need to seek physician approval prior to diving)
Do you have a pacemaker or medical implant that may be affected by magnets? Nemo has strong magnets and therefore must not be used by persons with pacemakers or medical implants that may be affected by magnets.*
No
Yes (If this is your answer, then you must not participate in Nemo diving. Stay at least 2 feet away from Nemo at all times.)
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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