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This is the New PADI form for all activities including riding on a boat.

This waiver is good for one year

Release of Liability/Assumption of Risk/Non-agency Acknowledgment Form
DIVER ACTIVITIES
Please read carefully and fill in all blanks before signing.


NON-AGENCY DISCLOSURE AND ACKNOWLEDGMENT AGREEMENT


I understand and agree that PADI Members (“Members”), including The Scuba Shop,Llc (PADI store #1333), 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 liable
for the actions, inactions or negligence of the entities listed above 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 scuba diver trained in safe dive practices,
or a student diver under the control and supervision of a certified scuba instructor. I know that skin diving, freedivng and scuba
diving have inherent risks including those risks associated with boat travel to and from the dive site (hereinafter “Excursion”), which
may result in serious injury or death. I understand that scuba diving with compressed air involves certain inherent risks; including but
not limited to decompression sickness, embolism or other hyperbaric/air expansion injury that require treatment in a recompression
chamber. If I am scuba diving with oxygen enriched air (“Enriched Air”) or other gas blends including oxygen, I also understand that
it involves inherent risks of oxygen toxicity and/or improper mixtures of breathing gas. I acknowledge this Excursion includes risks
of slipping or falling while on board the boat, 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. I further understand that the Excursion will be conducted at a site that is remote, either
by time or distance or both, from a recompression chamber. I still choose to proceed with the Excursion in spite of the absence of a
recompression chamber in proximity to the dive site(s).


I understand and agree that neither The Scuba Shop,Llc (PADI store #1333); nor the dive professional(s) who may
be present at the dive site, nor PADI Americas, Inc., nor any of their affiliate and subsidiary corporations, nor any of their respective
employees, officers, agents, contractors and assigns (hereinafter “Released Parties”) may be held liable or responsible in any way for
any injury, death or other damages to me, my family, estate, heirs or assigns that may occur during the Excursion as a result of my
participation in the 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 for the Excursion. I further state that I will not participate in the Excursion if I am
under the influence of alcohol or any drugs that are contraindicated 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 diving is a physically
strenuous activity and that I will be exerting myself during the 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. I am aware 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).


If diving from a boat, I will be present at and attentive to the briefing given by the boat crew. If there is anything I do not understand
I will notify the boat crew or captain immediately. I acknowledge it is my responsibility to plan my dives as no-decompression dives,
and within parameters that allow me to make a safety stop before ascending to the surface, arriving on board the vessel with gas
remaining in my cylinder as a measure of safety. If I become distressed on the surface I will immediately drop my weights and inflate
my BCD (orally or with low pressure inflator) to establish buoyancy on the surface.


I am aware safe dive practices recommend a refresher or guided orientation dive following a period of diving inactivity. I understand
such refresher/guided dive is available for an additional fee. If I choose not to follow this recommendation I will not hold the Released
Parties responsible for my decision.


I acknowledge Released Parties may provide an in-water guide (hereinafter “Guide”) during the Excursion. The Guide is present to
assist in navigation during the dive and identifying local flora and fauna. If I choose to dive with the Guide I acknowledge it is my
responsibility to stay in proximity to the Guide during the dive. I assume all risks associated with my choice whether to dive in proximity
to the Guide or to dive independent of the Guide. I acknowledge my participation in diving is at my own risk and peril.


I affirm it is my responsibility to inspect all of the equipment I will be using prior to the leaving the dock for the Excursion and that I
should not dive if the equipment is not functioning properly. I will not hold the Released Parties responsible for my failure to inspect
the equipment prior to diving or if I choose to dive with equipment that may not be functioning properly.


I acknowledge Released Parties have made no representation to me, implied or otherwise, that they or their crew can or will perform
affective rescues or render first aid. In the event I show signs of distress or call for aid I would like assistance and will not hold the
Released Parties, their crew, dive boats or passengers responsible for their actions in attempting the performance of rescue or first aid.


I hereby state and agree that this Agreement will be effective for all Excursions in which I participate for one (1) year from the date
on which I sign this Agreement.


I further state that I am of lawful age and legally competent to sign this liability release, or that I have acquired 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, 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 THE RELEASED
PARTIES DEFINED ABOVE FROM ALL LIABILITY OR 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 BELOW ON
BEHALF OF MYSELF AND MY HEIRS.

 

If you have DAN insurance please provide the information bellow...

Please select who will be participating...
AdultMinor
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First Participant Name

First Name*

Last Name*
First Participant Date of Birth*
I certify that I am 18 years of age or older
First Participant Information
Do You Have DAN Insurance*
No
Yes

DAN Membership Number
First Participant Signature*
Parent or Guardian's Email Address

Email
Check to receive emails from The Scuba Shop. Stay up to date with all our Scuba Events.
A signed copy of this waiver will be sent to the email address you provide.
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*
Parent or Guardian's Date of Birth*
I certify that I am 18 years of age or older
Parent or Guardian's Information
Do You Have DAN Insurance*
No
Yes

DAN Membership Number
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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