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For Unguided and Unsupervised Boat Dives for Certified Divers

I, UNDERSIGNED, hereby affirm that I have been advised and thoroughly informed of the inherent hazards of scuba diving activities and participation in a unguided unsupervised tour as a certified diver.

Further, I understand that diving with compressed air, oxygen enriched air (Nitrox), and trimix supplied by standard open circuit scuba or with semi-closed circuit or closed circuit rebreathers involves certain inherent risks including decompression sickness, embolism, oxygen toxicity, inert gas narcosis, hypoxia, hypercapnia, marine life injuries or other barotrauma or hyperbaric injuries. Such injuries can occur that require treatment in a recompression chamber or medical facility. I further understand that dive activities can be at remote sites, and isolated by time and distance, from such a recompression chamber or medical facility. I still choose to proceed with such dives in spite of the absence of a recompression chamber in proximity to the dive site.

I understand and agree that neither the captain and crew, Shane Coote, nor any of the respective employees, officers, agents or assigns of, Scuba Shane Diving, (hereinafter referred to as “Released Parties”) may be held liable or responsible in any way for any injury, death, or other damages to me or my family, heirs, or assigns that may occur as a result of my participation in this diving activity or as a result of the negligence of any party, including the Released Parties, whether passive or active.

In consideration of being allowed to participate in this activity I hereby personally assume all risks in connection with said trip, for any harm, injury, or damage that may befall me while I am a diving participant including all risks connected therewith, whether foreseen or unforeseen.

I further agree to save, defend, indemnify, and hold harmless said Released Parties from any claim or lawsuit by me, anyone purporting to act on my behalf, my family, estate, heirs or assigns, arising directly or indirectly out of my participation and diving activities including claims arising during this activity even if such claims may be groundless, false or fraudulent.

I also understand that diving activities are physically strenuous and that I will be exerting myself during this diving trip and that if I am injured as a result of heart attack, panic, hyperventilation, oxygen toxicity, inert gas narcosis, drowning, etc. that I expressly assume the risk of said injuries and that I will not hold the above listed individuals or companies responsible for the same, and I agree to defend, indemnify, and hold harmless said Released Parties for any such injuries incurred by me.

I understand that these activities may place me deeper than I am able to safely execute a free ascent (without breathing gas) from.

I understand that I may be required to furnish some of my own equipment and that I am responsible for its operating condition and maintenance.

I understand that I may be supplied with certain items of scuba equipment and that I am responsible for reviewing its proper function and operating condition prior to using it.

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 that the terms herein are contractual and not a mere recital, and that I have signed this document of my own free act. Further that I understand and agree that, in the event that one or more of the provisions of this agreement, for any reason, is held by a court of competent jurisdiction to be invalid or unenforceable in any respect, such invalidity, illegality or unenforceability shall not affect any other provision hereof, and this agreement shall be construed as if such invalid, illegal or unenforceable provision or provisions had never been contained herein.

IT IS THE INTENTION OF THE UNDERSIGNED BY THIS INSTRUMENT TO EXEMPT AND RELEASE THE CAPTAIN/ CREW , THE VESSEL, THE BUSINESS SCUBA SHANE DIVING AND ALL OTHER RELATED ENTITIES AND RELEASED PARTIES AS DEFINED ABOVE, FROM ALL LIABILITY OR RESPONSIBILITY WHATSOEVER FOR PERSONAL INJURY, PROPERTY DAMAGE OR WRONGFUL DEATH HOWEVER CAUSED, OR ARISING OUT OF, DIRECTLY OR INDIRECTLY, INCLUDING, BUT NOT LIMITED TO, THE NEGLIGENCE OF THE RELEASED PARTIES, WHETHER PASSIVE OR ACTIVE. I HAVE FULLY INFORMED MYSELF OF THE CONTENTS OF THIS LIABILITY RELEASE AND EXPRESS ASSUMPTION OF RISK BY READING IT BEFORE SIGNING IT ON BEHALF OF MYSELF AND MY HEIRS.

First Scuba Diver Name

First Name*

Last Name*

Phone*
First Scuba Diver Date of Birth*
First Scuba Diver Information

I further state that I am already a qualified and certified scuba diver from the following training agencies: *

and that I hold training to the level of *

I am aware of the required certification level and/or experience necessary and recommended to enroll in this diving activity and I stipulate that I meet those requirements for prior certification or equivalent experience.


I have been a certified diver since: *

I have been diving for: how many years? *

Total number of dives: *

To a maximum depth of: How many meters? *
First Scuba Diver Signature*
Second Scuba Diver Name

First Name*

Last Name*
Second Scuba Diver Date of Birth*
Second Scuba Diver Information

I further state that I am already a qualified and certified scuba diver from the following training agencies: *

and that I hold training to the level of *

I am aware of the required certification level and/or experience necessary and recommended to enroll in this diving activity and I stipulate that I meet those requirements for prior certification or equivalent experience.


I have been a certified diver since: *

I have been diving for: how many years? *

Total number of dives: *

To a maximum depth of: How many meters? *
Third Scuba Diver Name

First Name*

Last Name*
Third Scuba Diver Date of Birth*
Third Scuba Diver Information

I further state that I am already a qualified and certified scuba diver from the following training agencies: *

and that I hold training to the level of *

I am aware of the required certification level and/or experience necessary and recommended to enroll in this diving activity and I stipulate that I meet those requirements for prior certification or equivalent experience.


I have been a certified diver since: *

I have been diving for: how many years? *

Total number of dives: *

To a maximum depth of: How many meters? *
Fourth Scuba Diver Name

First Name*

Last Name*
Fourth Scuba Diver Date of Birth*
Fourth Scuba Diver Information

I further state that I am already a qualified and certified scuba diver from the following training agencies: *

and that I hold training to the level of *

I am aware of the required certification level and/or experience necessary and recommended to enroll in this diving activity and I stipulate that I meet those requirements for prior certification or equivalent experience.


I have been a certified diver since: *

I have been diving for: how many years? *

Total number of dives: *

To a maximum depth of: How many meters? *
Fifth Scuba Diver Name

First Name*

Last Name*
Fifth Scuba Diver Date of Birth*
Fifth Scuba Diver Information

I further state that I am already a qualified and certified scuba diver from the following training agencies: *

and that I hold training to the level of *

I am aware of the required certification level and/or experience necessary and recommended to enroll in this diving activity and I stipulate that I meet those requirements for prior certification or equivalent experience.


I have been a certified diver since: *

I have been diving for: how many years? *

Total number of dives: *

To a maximum depth of: How many meters? *
Sixth Scuba Diver Name

First Name*

Last Name*
Sixth Scuba Diver Date of Birth*
Sixth Scuba Diver Information

I further state that I am already a qualified and certified scuba diver from the following training agencies: *

and that I hold training to the level of *

I am aware of the required certification level and/or experience necessary and recommended to enroll in this diving activity and I stipulate that I meet those requirements for prior certification or equivalent experience.


I have been a certified diver since: *

I have been diving for: how many years? *

Total number of dives: *

To a maximum depth of: How many meters? *
Seventh Scuba Diver Name

First Name*

Last Name*
Seventh Scuba Diver Date of Birth*
Seventh Scuba Diver Information

I further state that I am already a qualified and certified scuba diver from the following training agencies: *

and that I hold training to the level of *

I am aware of the required certification level and/or experience necessary and recommended to enroll in this diving activity and I stipulate that I meet those requirements for prior certification or equivalent experience.


I have been a certified diver since: *

I have been diving for: how many years? *

Total number of dives: *

To a maximum depth of: How many meters? *
Eighth Scuba Diver Name

First Name*

Last Name*
Eighth Scuba Diver Date of Birth*
Eighth Scuba Diver Information

I further state that I am already a qualified and certified scuba diver from the following training agencies: *

and that I hold training to the level of *

I am aware of the required certification level and/or experience necessary and recommended to enroll in this diving activity and I stipulate that I meet those requirements for prior certification or equivalent experience.


I have been a certified diver since: *

I have been diving for: how many years? *

Total number of dives: *

To a maximum depth of: How many meters? *
Ninth Scuba Diver Name

First Name*

Last Name*
Ninth Scuba Diver Date of Birth*
Ninth Scuba Diver Information

I further state that I am already a qualified and certified scuba diver from the following training agencies: *

and that I hold training to the level of *

I am aware of the required certification level and/or experience necessary and recommended to enroll in this diving activity and I stipulate that I meet those requirements for prior certification or equivalent experience.


I have been a certified diver since: *

I have been diving for: how many years? *

Total number of dives: *

To a maximum depth of: How many meters? *
Tenth Scuba Diver Name

First Name*

Last Name*
Tenth Scuba Diver Date of Birth*
Tenth Scuba Diver Information

I further state that I am already a qualified and certified scuba diver from the following training agencies: *

and that I hold training to the level of *

I am aware of the required certification level and/or experience necessary and recommended to enroll in this diving activity and I stipulate that I meet those requirements for prior certification or equivalent experience.


I have been a certified diver since: *

I have been diving for: how many years? *

Total number of dives: *

To a maximum depth of: How many meters? *
Parent or Guardian's Email Address

Email*

Confirm Email*
Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone Number*
This waiver remains valid for 1 year unless your circumstances or details change in which case you must notify us prior to your next dive and complete a new waiver.
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

I further state that I am already a qualified and certified scuba diver from the following training agencies: *

and that I hold training to the level of *

I am aware of the required certification level and/or experience necessary and recommended to enroll in this diving activity and I stipulate that I meet those requirements for prior certification or equivalent experience.


I have been a certified diver since: *

I have been diving for: how many years? *

Total number of dives: *

To a maximum depth of: How many meters? *
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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