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The following Great Lakes Shipwreck Preservation Society diver liability waiver is required to be completed by each diver before an activity takes place.

This is a release of your rights to sue Great Lakes Shipwreck Preservation Society (GLSPS) and/or any of its owners, employees, agents and assignees, volunteers, the vessel R/V Preservation, owner of the vessel, the captain and crew of the vessel, and all associated entities’ (together and individually the "Released Parties") for personal injuries, wrongful death or property damage that may occur during your upcoming project as a result of the inherent risk associated with boating, scuba diving, and/or technical diving.

Please read and acknowledge each of the below items:

I acknowledge that I am a certified scuba diver, or under an instructor’s supervision, and trained in safe diving practices.  I have been advised of and fully understand the inherent hazards of scuba diving/technical diving (including rebreather diving) activities. I further acknowledge that I am trained to the level that I, myself, deem necessary to complete the scheduled dives in a safe manner.

I Agree

I understand that the inherent risks of scuba diving include, but are not limited to: pre-existing health issues leading to injury, drowning, panic, pressure related injuries, decompression sickness, over-expansion injuries, embolism, gas toxicity, slipping, or falling while on board, being cut or struck by the boat while in the water, injuries occurring while getting on or off a boat, becoming lost or disoriented at depth, environmental factors which lead to injury, equipment problems leading to injury, buoyancy problems, fire and/or explosive hazards, improper dive planning, improper action of other divers or support personnel (including failure to rescue, recover, resuscitate, or provide medical assistance), poor judgement, along with other unforeseen risk; all of which can result in serious injury, drowning and/or death.  I understand that diving with compressed air, oxygen enriched air, or other gas blends including oxygen supplied by standard open circuit, semi-closed or fully closed-circuit rebreathers, involves certain inherent risk including, but not limited to oxygen toxicity, hypoxia, hypercapnia, inert gas narcosis, and/or improper mixtures of breathing gas.

I Agree

I understand that scuba diving is a physically strenuous activity and that I will be exerting myself during this diving excursion, and that if I am injured because of a heart attack, panic, hyperventilation, or other reasons. that I expressly assume the risk of said injuries that I will not hold the Released Parties responsible for the same.

I Agree

I fully understand and am aware that the R/V Preservation has limited medical facilities and that in the event of illness or injury, appropriate medical care must be summoned using available communications and that treatment will be delayed until I can be transported to a proper medical care facility.  I further understand that this activity may be conducted in a remote area where medical attention may not be available.  Nevertheless, I expressly agree to proceed with the project/trip.

I Agree

Released Parties have made no representation to me implied or otherwise, that they or their crew will perform safe rescues, or render first aid.  In the event I show signs of distress, call for aid or assistance I will not hold Released Parties responsible for their actions in attempting the performance of a rescue or first aid.

I Agree

I affirm that I am in good mental and physical fitness for diving, and that I am not under the influence of any medications or drugs.  If I am taking medication(s) or drugs, I affirm that I have consulted with a physician and have been approved to dive under the influence of the medication(s) or drug(s).  I will not hold Released Parties responsible for any adverse reaction(s) while under the influence of medications or drugs.

I Agree

I affirm that I have inspected all my equipment, including all borrowed, personal, and/or rented equipment, prior to diving and will notify Released Parties if any of my equipment is not working properly.  I will not hold Released Parties responsible for my failure to inspect my equipment prior to diving.  I also agree to hold harmless Released Parties should any of my dive equipment fail at any time.

I Agree

I will pay attention to the safety briefing given by Released Parties and ask any questinos I may have.  I understand that I, myself, am responsible for my safety at all times including above or below water.  I agree that I will plan my dives in a safe manner and execute them in a safe manner.  I agree to follow all safe diving practices that I have been trained for in my scuba diving classes.  I agree that I will immediately cease and abort my dive should I feel uncomfortable at any time.

I Agree

I understand that water conditions may change while we are under way, underwater diving, or any time during the trip and that this is a function of the environment.  The captain and crew of any vessel must make decisions based on their best information at the time.  I will not hold Released Parties responsible for weather/sea conditions over which they have no control or decisions made by any captain or crew.

I Agree

I understand that it is unlawful to remove any shipwreck artifact(s) at any time.  I will not remove any shipwreck artifact.  I understand that if I do this, it is without the knowledge of anyone else, and I am solely responsible for my actions.

I Agree

 

I have fully informed myself of the contents of this information and release by reading it before I signed it on behalf of myself and/or heirs.
*It is also my intention that this release is to be continuing in nature, and will apply to any injuries and/or death arising out of, or related to, any diving activities I participate in with the released parties after the reference date of my signature unless specifaclly revoked by me in writing which can have only a prospective impact to this Release.

November 30, 2021

First Participant's Name

First Name*

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Information

Highest Certification Level *

Certification Agency *
First Participant's Signature*
Second Participant's Name

First Name*

Last Name*

Phone*
Second Participant's Date of Birth*
Second Participant's Information

Highest Certification Level *

Certification Agency *
Third Participant's Name

First Name*

Last Name*

Phone*
Third Participant's Date of Birth*
Third Participant's Information

Highest Certification Level *

Certification Agency *
Fourth Participant's Name

First Name*

Last Name*

Phone*
Fourth Participant's Date of Birth*
Fourth Participant's Information

Highest Certification Level *

Certification Agency *
Fifth Participant's Name

First Name*

Last Name*

Phone*
Fifth Participant's Date of Birth*
Fifth Participant's Information

Highest Certification Level *

Certification Agency *
Sixth Participant's Name

First Name*

Last Name*

Phone*
Sixth Participant's Date of Birth*
Sixth Participant's Information

Highest Certification Level *

Certification Agency *
Seventh Participant's Name

First Name*

Last Name*

Phone*
Seventh Participant's Date of Birth*
Seventh Participant's Information

Highest Certification Level *

Certification Agency *
Eighth Participant's Name

First Name*

Last Name*

Phone*
Eighth Participant's Date of Birth*
Eighth Participant's Information

Highest Certification Level *

Certification Agency *
Ninth Participant's Name

First Name*

Last Name*

Phone*
Ninth Participant's Date of Birth*
Ninth Participant's Information

Highest Certification Level *

Certification Agency *
Tenth Participant's Name

First Name*

Last Name*

Phone*
Tenth Participant's Date of Birth*
Tenth Participant's Information

Highest Certification Level *

Certification Agency *
Parent or Guardian's Email Address

Email*

Confirm Email*
Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone Number*
Dive Insurance

Insurance Carrier

Insurance Policy 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*

Relationship*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Information

Highest Certification Level *

Certification Agency *
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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