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Key Largo Dive Center
100670 Overseas Highway
Key Largo, FL 33037

Statement of Risks and Liability for Enriched Air (Nitrox) Diving

Please read carefully before signing.

This is a statement in which you are informed of the risks of skin and scuba diving and the particular hazards of scuba diving with enriched air. The statement also sets out the circumstances in which you participate in the diving program at your own risk.

Your signature on this statement is required as proof that you have received and read this statement. It is important that you read the contents of this statement before signing it. If you do not understand anything contained in this statement, then please discuss it with your instructor. If you are a minor, this form must also be signed by a parent or guardian.

WARNING

Skin and scuba diving have inherent risks which may result in serious injury or death.

Diving with oxygen enriched air ("Enriched Air") involves certain inherent risks of oxygen toxicity and/or improper mixtures of breathing gas. Also, diving with compressed air involves certain inherent risks; decompression sickness, embolism or other hyperbaric injury can occur that require treatment in a recompression chamber. Open water diving trips which are necessary for training and for certification, may be conducted at a site that is remote, either by time or distance or both, from such a recompression chamber. Skin and scuba diving are physically strenuous activities and you will be exerting yourself during this diving program. You must advise truthfully and fully inform the dive professionals and the facility through which this program is offered of your medical history.

EXCLUSION OF LIABILITY

I understand and agree that neither the dive professionals conducting this program, nor the facility through which this program is conducted, Key Largo Dive Center, nor PADI International Ltd., nor PADI Americas, Inc., nor their affiliate or subsidiary corporations, nor any of their respective employees, officers, agents or assigns (hereinafter referred to as "Released Parties") accept any responsibility for any death, injury or other loss suffered or caused by me or resulting from my own conduct or any matter or condition under my control that amounts to my own contributory negligence.

In the absence of any negligence or other breach of duty by the dive professionals conducting this program, the facility through which this program is offered, Key Largo Dive Center, PADI International Ltd., PADI Americas, Inc., and all released entities and released parties as defined above, my participation in this diving program is entirely at my own risk.

I acknowledge receipt of this Statement and have read all of the terms before signing this Statement.

I Agree

First Diver's Name

First Name*

Middle Name

Last Name*

Phone*
First Diver's Date of Birth*
First Diver's Signature*
Second Diver's Name

First Name*

Middle Name

Last Name*
Second Diver's Date of Birth*
Second Diver's Signature*
Third Diver's Name

First Name*

Middle Name

Last Name*
Third Diver's Date of Birth*
Third Diver's Signature*
Fourth Diver's Name

First Name*

Middle Name

Last Name*
Fourth Diver's Date of Birth*
Fourth Diver's Signature*
Fifth Diver's Name

First Name*

Middle Name

Last Name*
Fifth Diver's Date of Birth*
Fifth Diver's Signature*
Sixth Diver's Name

First Name*

Middle Name

Last Name*
Sixth Diver's Date of Birth*
Sixth Diver's Signature*
Seventh Diver's Name

First Name*

Middle Name

Last Name*
Seventh Diver's Date of Birth*
Seventh Diver's Signature*
Eighth Diver's Name

First Name*

Middle Name

Last Name*
Eighth Diver's Date of Birth*
Eighth Diver's Signature*
Ninth Diver's Name

First Name*

Middle Name

Last Name*
Ninth Diver's Date of Birth*
Ninth Diver's Signature*
Tenth Diver's Name

First Name*

Middle Name

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

Email*

Confirm Email*
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You are agreeing to let your minor child engage in a potentially dangerous activity. You are agreeing that, even if Key Largo Dive Center including their staff, management, and employees 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 Key Largo Dive Center including their staff, management, and employees 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 Key Largo Dive Center has the right to refuse to let your child participate if you do not sign this form. INSTRUCTIONS FOR ADDENDUM FOR USE IN FLORIDA These instructions are to assist you in completing the Addendum for Use in Florida. 1. The Addendum for Use in Florida must be completed for all snorkeling, skin and/or scuba diving instruction or supervised activity which takes place within the State of Florida. 2. The Addendum for Use in Florida must be completed with respect to all minor children who participate in snorkeling, skin and/or scuba diving instruction or supervised activities in the State of Florida, regardless of whether the minor child and/or the natural guardian is a resident of or lives in the State of Florida. 3. A minor child, as that term is used in the Addendum for Use in Florida, means a person under 18 years of age at the time the Addendum for Use in Florida is completed. 4. The Addendum for Use in Florida is NOT a replacement for the release of liability, waiver of claims, express assumption of risk and indemnity agreement, but is to be completed in addition to that agreement when a minor child is the participant. 5. Please make sure that the Addendum for Use in Florida is completed, signed, and dated before any participation by a minor child in any snorkeling, skin and/or scuba diving instruction and/or supervised activity takes place.
Parent or Guardian's Name

First Name*

Middle Name

Last Name*

Relationship*

Phone*
Parent or Guardian's Date of Birth*
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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