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CONTINUING WAIVER & RELEASE OF LIABILITY, ASSUMPTION OF RISK & INDEMNITY, AND EMERGENCY CARE PERMISSION

PLEASE READ CAREFULLY BEFORE SIGNING BECAUSE THIS IS A CONTINUING RELEASE OF LIABILITY AND WAIVER OF CERTAIN LEGAL RIGHTS. IT ALSO GRANTS CONTINUING PERMISSION FOR EMERGENCY CARE.

In consideration of permitting me, (participant), to enroll in a swim, snorkeling, or scuba diving instructional course and/or participate in Swimming, Snorkeling, Scuba Diving, Swim Parties, Physical Activities, and Related Operations (hereafter known as “Water Activities”) conducted by DiVentures Holdings, LLC or any DiVentures Subsidiaries (as defined below), beginning on December 7, 2022, I agree for myself, my personal representatives, heirs and next of kin:

I hereby acknowledge that Water Activities are potentially dangerous activities and involve the inherent risk of serious injury (including paralysis), death and/or property damage both in and under the water as well as on the pool deck itself.

I hereby release, waive, discharge and agree not to sue DiVentures Holdings, LLC; its subsidiaries DiVentures, LLC, DiVentures Iowa, LLC, DiVentures Springfield, LLC, DiVentures Madison, LLC, DiVentures Columbia, LLC, DiVentures Atlanta, LLC, DiVentures Lexington, LLC, DiVentures Kansas City, LLC, DiVentures Lincoln, LLC, DiVentures Battle Creek, LLC, DiVentures Arizona, LLC, DiVentures Marietta, LLC, DiVentures Memphis, LLC, DiVentures Little Rock, LLC , and DiVentures Virginia, LLC (collectively, “DiVentures Subsidiaries”) and their respective facilities, staff, officers, instructors, agents or employees (collectively, the “Releasees”) from all liability to myself, my minor child(ren), my personal representatives, signs, heirs and next of kin for any and all loss or damage and any claim or demands therefore on account of injury to my person or property or resulting in my death, now and forever, arising out of or related to participation and/or instruction in said course, activities or any other related Water Activities that may occur.

I hereby assume full responsibility for any risk of bodily injury, death or property damage, now and forever, arising out of or related to participation and/or instruction in said course, Water Activities, or any other swimming/snorkeling operations conducted by DiVentures Holdings, LLC or any DiVentures Subsidiaries.

I hereby acknowledge that this Waiver and Release of Liability is intended to be as broad and inclusive as permitted by the laws of the state in which the activities are conducted, and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect.

I hereby assume full responsibility for determining the need for and providing an interpreter for a language other than English within the facility.

I acknowledge that it is my responsibility to provide for my own and/or my child(ren)’s own accident and health coverage while participating in Water Activities.

In the event I cannot be reached and/or am incapacitated or otherwise able to give consent, I give permission for emergency medical, surgical and hospital treatment and procedures to be performed by a licensed physician or hospital, when deemed immediately necessary to safeguard my/my child(ren)’s health. I relieve Releasees of any and all responsibility for action(s) taken by the doctor(s), hospitals, or other medical care providers in the treatment and attendance of me or my child.

I agree that this waiver, release of liability, assumption of the risk, and consent for emergency medical, surgical and hospital treatment shall be continuing and effective for all Water Activities conducted by or on behalf of the above named Releasees for a period of time beginning with the execution of this document and terminating at 11:59 P.M., CST, on the 365th day after the date on which this document was signed.

Swimmers Using Aquatic Facilities

ASSUMPTION OF RISK, LIABILITY RELEASE & HOLD HARMLESS AGREEMENT

This is a legal contract terminating your rights to file a lawsuit. Read carefully before signing.

THERE IS NO LIFEGUARD ON DUTY – SWIM AT YOUR OWN RISK! 

Participating in Activities such as swimming, snorkeling, mermaiding and freediving at an aquatic facility including getting in and out of water and on wet surfaces without a lifeguard has inherent risks. While participating in unsupervised swimming, swimming laps and snorkeling, (hereafter called “Activities”) I may be exposed to an unlimited number of risks which may cause serious personal illness, injury or death. In consideration of being allowed to participate in unsupervised Activities I assume all risks associated with all unsupervised Activities. Risk of injury or death including but not limited to drowning may occur as a result of participating in the Activities. Other risks may be encountered due to improper, insufficient, inoperable, or inadequate equipment. Additionally, I may be exposed to risks associated with human factors such as my ability to swim or keep my head above the surface, preexisting or poor medical and fitness conditions, and the possible action or inaction of others that may cause me injury or death. These risks are some but not an all-inclusive list of all risks I may be exposed to while participating in the Activities. I will be solely responsible for my health, safety, and actions at all times while participating in Activities. I will follow safe practices, maintain awareness and use good judgment set forth in the applicable SSI Responsible Code to reduce the risks, however, I know the risk of property loss, illness, injury and or death cannot be eliminated. By signing this Agreement, I hereby agree to assume all risks associated with unsupervised Activities, including the risk of injury and death, whether foreseen or unforeseen.

By signing this Agreement, I am giving up the legal right to sue the aquatic facility, its owners, officers and directors, employees, agents, operators, volunteers, instructors, counselors, or its insurance company, land owners, third parties or anyone else specifically named or unnamed (hereafter called “Released Parties”) as a result of my or anyone else’s injury or death as a result of unsupervised Activities. I understand that the Released Parties are under no obligation to provide instructions, rescue, first aid, medical care, emergency transportation, or recovery of the participant. In consideration of being allowed to participate in Activities at the aforementioned aquatic facility, I hereby agree to give up my right to sue and I hereby release the aforementioned Released Parties from any liability in connection with the Activities which may result in injury or death, including but not limited to property damage, illness, injury, or death caused to me or any others due to negligence caused by someone doing something they should not have done or caused by someone not doing something they should have or any other cause including negligence caused by the Released Parties which may have caused property damage, illness, injury or death. I hereby give up these legal rights on behalf of myself, my estate, my family, heirs, assigns or any other party that may have a legal claim against the Released Parties.

By signing this document, I hereby waive all claims arising by me, my family, heirs, assigns or any other party who may have a claim against the Released Parties as a result of my participation in the Activities. Furthermore, I agree to indemnify the Released Parties from any responsibility or liability for any loss, costs, attorneys’ fees, liabilities, damages, illness, injury or death arising from my participation in the Activities with the Released Parties. It is my specific contract, by signing this document, that I will not present a claim, cause of action, lawsuit or otherwise for any damage, illness, injury or death caused to me or any other party including minor children for whom I may have a legal right in connection with any activity associated with the Released Parties. In the event I violate this Agreement I agree to be held responsible and liable for all damages, expenses, fees and cost associated with Released Parties defending and or paying claims brought on my behalf. In the event I cause Released Parties damage or expense associated with my participation in the Activities, I agree to be responsible and liable for same and will agree to pay as if fully adjudicated by a competent legal court.

I understand and agree the SSI licenses training centers, professionals and their affiliates to use various SSI trademarks and to conduct SSI approved training, but they are not agents, employees or franchisees of SSI, its parent, subsidiary, or affiliated corporations. I further understand SSI training centers, SSI professionals, and their affiliates’ businesses are independent, and are neither owned, operated, or controlled by SSI, and that while SSI establishes standards and materials for SSI training, it is not responsible for, nor does it have the right to control, the operation of the business activities or the day-to-day training and or supervision of Participants by SSI training centers, SSI professionals, their affiliated businesses, and/or their associated staff. I further understand and agree on behalf of myself, that in the event of injury, illness or death during the Activities, I shall not hold SSI liable for the actions, inactions or negligence of the SSI training center, SSI professionals and other affiliated businesses or personnel associated with my participation in the Activities.

This Agreement is a legally binding contract. By signing it I am agreeing to all of its terms and conditions and representing that I have read and understand it thoroughly before signing it. I have signed this Agreement voluntarily and of my own free act. I agree to all of the terms, conditions and provisions of this Agreement without modification from its preprinted form. Furthermore, I agree that if any provision of this document is found to be void or unlawful, the remainder of the contract shall remain in full force and effect. By signing this document, I affirm that I have read, understand, and agree to be legally bound by all of the provisions of this Agreement.

If the swim participant is under the age of 18, they must be accompanied by a parent or guardian to participate in the Activities. The parent or guardian must sign the SSI Youth Addendum and agree to be legally responsible for the minor participant, including being responsible for all damage, illness, injury or death which may occur as a result of the minor’s participation in the Activities. The parent or guardian hereby agrees to be fully responsible to the Released Parties for any damage, illness, injury or death caused by the minor, including actions brought by the minor, for any damages whatsoever.

Scuba Divers Using Aquatic Facilities

ASSUMPTION OF RISK, LIABILITY RELEASE & HOLD HARMLESS AGREEMENT

This is a legal contract terminating your rights to file a lawsuit. Read carefully before signing

THERE IS NO LIFEGUARD ON DUTY – SCUBA DIVE AT YOUR OWN RISK!

Participating in unsupervised swimming activities such as a scuba diving in an aquatic facility is inherently dangerous. While participating in unsupervised scuba diving, snorkeling and swimming in the aquatic facility, (hereafter called “Activities”) I may be exposed to risks which may cause serious personal illness, injury or death. In consideration of being allowed to participate in unsupervised Activities I expressly assume all risks associated with the Activities. Risk of illness, injury or death may arise due to improper, insufficient, inoperable, or inadequate equipment among other things. I will be solely responsible for my health, safety, and actions at all times while participating in Activities. I will follow safe practices, maintain awareness and use good judgment set forth in the applicable SSI Responsible Code to reduce the risks, however, I know the risk of property loss, illness, injury and or death cannot be eliminated. I represent that I am a certified and competent scuba diver and swimmer. I am solely responsible to verify the function and adequacy of the equipment I use and to monitor my gas supply throughout my Activities. At no time will I attempt a skill or act that I am not certified to perform. At no time will I instruct others in scuba diving or allow non-certified divers to use my scuba equipment. In the event I choose to dive without a partner I understand and accept the increased risk and danger of solo diving. I understand the Activities will expose me to inherent risks including but not limited to; panic, drowning, decompression illness, overexpansion injuries, pressure related injuries, breathing gas toxicities, equipment failure, and dangerous acts of others. I UNDERSTAND THERE ARE RISKS OF PROPERTY LOSS, ILLNESS, INJURY AND DEATH EVEN WHEN DIVING IN THE SHALLOW DEPTHS OF AN AQUATIC FACILITY. I VOLUNTARILY CHOOSE TO PARTICIPATE IN THE ACTIVITIES AND ASSUME ALL RISKS ASSOCIATED WITH THE ACTIVITIES, WHETHER FORESEEN OR UNFORESEEN, AND WHETHER CREATED OR NOT BY THE RELEASED PARTIES OR NOT.

By signing this Agreement I am giving up the legal right to sue the aquatic facility its owners, officers and directors, employees, agents, operators, volunteers, instructors, counselors, or its insurance company, land owners, third parties or anyone else specifically named or unnamed (hereafter called “Released Parties”) as a result of my or anyone else’s injury or death as a result of my participation in the Activities. In consideration of being allowed to participate in Activities in the aforementioned aquatic facility, I hereby agree to give up my right to sue and I hereby release the Released Parties from any liability in connection with the Activities, including but not limited to property damage, illness, injury, or death caused to me or any others due to negligence caused by someone doing something they should not have done or caused by someone not doing something they should have or any other cause including negligence on the part of the Released Parties. I hereby give up these legal rights on behalf of myself, my estate, my family, heirs, assigns or any other party that may have a legal claim against the Released Parties.

By signing this document, I hereby waive all claims and legal rights of mine, my family, heirs, assigns or any other party who may have a claim against the Released Parties as a result of my participation in the Activities. Furthermore, I agree to indemnify the Released Parties from any responsibility or liability for any loss, costs, attorneys’ fees, liabilities, damages, illness, injury or death arising from my participation in the Activities. It is my specific intent, by signing this document, that I will not present a claim, cause of action, lawsuit or otherwise for any damage, illness, injury or death caused to me or any other party including minor children for whom I may have a legal right in connection with any Activity associated with the Released Parties. In the event I violate this Agreement I agree to be held responsible and liable for all damages, expenses, fees and costs associated with the Released Parties defending and or paying claims brought on my behalf. In the event I cause the Released Parties damage or expense associated with my participation in the Activities, I agree on behalf of myself, my heirs and my estate to be responsible and liable for same and will agree to pay as if fully adjudicated by a competent legal court.

I understand and agree the SSI licenses training centers, professionals and their affiliates to use various SSI trademarks and to conduct SSI approved training, but they are not agents, employees or franchisees of SSI, its parent, subsidiary, or affiliated corporations. I further understand SSI training centers, SSI professionals, and their affiliates’ businesses are independent, and are neither owned, operated, or controlled by SSI, and that while SSI establishes standards and materials for SSI training, it is not responsible for, nor does it have the right to control, the operation of the business activities or the day-to-day training and or supervision of Participants by SSI training centers, SSI professionals, their affiliated businesses, and/or their associated staff. I further understand and agree on behalf of myself, that in the event of injury, illness or death during the Activities, I shall not hold SSI liable for the actions, inactions or negligence of the SSI training center, SSI professionals and other affiliated businesses or personnel associated with my participation in the Activities.

This Agreement is a legally binding contract. By signing it I am agreeing to all of its terms and conditions and representing that I have read and understand it thoroughly before signing it. I have signed this Agreement voluntarily and of my own free act. I agree to all of the terms, conditions and provisions of this contract without modification from its preprinted form. Furthermore, I agree that if any provision of this document is found to be void or unlawful that the remainder of the Agreement shall remain in full force and effect. By signing this document, I affirm that I have read, understand, and agree to be legally bound by all of the provisions of this Agreement.

Youth under age 18 (minors) are not permitted to scuba diving in the aquatic facility without being under the direct supervision of a certified and insured scuba professional. The parent or guardian must sign the SSI Youth Addendum and agree to be legally responsible for the minor participant, including being responsible for all damage, illness, injury or death which may occur as a result of the minor’s participation in the Activities. The parent or guardian hereby agrees to be fully responsible to the Released Parties for any damage, illness, injury or death caused by the minor, including actions brought by the minor, for any damages whatsoever.

Privacy Policy

This Privacy Policy explains why SSI Training Centers obtain your personal data for the purposes of conducting your training, issuing certifications, administration of your private information and any other necessary specifics regarding the performance of this agreement.

By registering in MySSI, you are consenting to share your personal data: Name (First and Last), Address (Postbox), Postcode (Zip), City, State, Country, Email Address, Telephone Numbers (optional), Date of Birth, Photo, Language, Gender, SSI Master ID, Course Type, Course Progress and Certification Information (Name, SSI Training Center, Certifying Instructor, Year You Started Diving, Level of Experience, Number of Dives and Issue Date), plus your Training Center Affiliation.

By giving your consent, SSI Training Centers may subsequently access your personal data described above in order to identify you, verify or confirm the status of your training and certifications and to offer you continued training and services based on your diving experience.

For more information you may go to the SSI Privacy Policy at https://my.divessi.com/myssi_privacy.

SSI Introductory Scuba Code - Assumption of Risk, Liability Release & Hold Harmless Agreement

(Form not to be used within the European Union and various other countries depending on local laws/regulations - The Training Center and the Professionals are responsible to know and adhere to laws/local regulations)

This form is used for SSI Try Scuba and SSI Basic Diver programs. This is a legal contract terminating your rights to file a lawsuit. Read carefully before signing. Warning – Scuba diving uses lifesupport equipment and techniques that have inherent risks that may cause injury, illness, or death.

In consideration of being allowed to participate in an SSI Introductory Scuba Program, I, (participant), expressly agree to be bound by this Agreement and comply with the Introductory Scuba Code described below. I understand this Agreement is between me, my family, estate, heirs, and/or anyone who may have a claim on my behalf, and (training center), including all instructors, facilities, boats, and dive sites; in addition to Scuba Schools International (“SSI”), and all respective owners, officers, employees, representatives, volunteers, agents, contractors, and any others on their behalves, whether specifically named or not (herein referred to as “Released Parties”).

I voluntarily assume all risks of injury, illness, and death, caused by scuba diving and all related activities, whether foreseeable or not, including but not limited to risks associated with; swimming, entering and exiting the water, falling on, being struck by or abandoned by a boat, holding my breath, pre-existing health conditions, heart failure, overexertion, panic, drowning, pressure-related injuries, decompression illness, environmental and marine life injuries, unknown causes, equipment malfunctions, improper dive planning, or improper action of other divers or support personnel (including failure to rescue, recover, resuscitate, or provide emergency assistance). I understand dive activities are conducted at sites that are remote, in time and distance, from medical care. I understand these risks and voluntarily choose to participate despite the risks.

I agree to be responsible to comply with the following SSI Introductory Scuba Code during all diving activities:

1. I am responsible for my own safety and well-being during all scuba dives, including but not limited to; equalizing my air spaces, breathing normally, maintaining proper buoyancy, and remaining with my dive leader throughout the dive.

2. I am responsible for being physically, medically, and mentally fit to participate in scuba diving; and I affirm all the personal information I have provided on the Fit to Dive questionnaire is truthful and accurate to the best of my knowledge; and I will not hold others responsible or liable for any injury, illness, or death caused by my failure to disclose a known medical condition.

3. I am responsible for monitoring my air supply and ending my dive with at least 500 psi/35 bar.

4. I am responsible for immediately notifying my dive leader if I am not comfortable or I have a problem.

5. I will remain with my dive leader throughout my dive; however, if I become separated and cannot locate my dive leader, I will ascend to the surface (making sure to exhale during ascent) and establish positive buoyancy by inflating my buoyancy compensator or releasing my weights.

6. I understand dive training does not guarantee my safety and that accidents happen even when proper procedures are followed.

7. In the event that I do not feel comfortable, capable, or willing to fulfill these Responsibilities then I will not dive.

I agree to waive, release, not sue, discharge, save, indemnify, and hold harmless the Released Parties of all claims, demands, causes of action, lawsuits and damages by me, my estate, family, heirs, or others who may have a claim for my injury, illness, or death as a result of any act or failure to act, including negligence by the Released Parties, associated with my introductory scuba experience and all related activities. I agree that it is my responsibility to inform my family and all those who may have legal rights on my behalf that I have entered into this Agreement and it is my intent that they be bound by the Agreement. I agree that me or my estate shall be fully liable for the cost to Released Parties for any claim brought on my behalf arising from my participation in scuba diving and all related activities.

I understand SSI licenses SSI Training Centers, SSI Professionals, and their affiliates to use various SSI trademarks and to conduct SSI training, but I agree they are not agents, employees, or franchisees of SSI, its parent, subsidiary, or affiliated corporations. I further understand that SSI Training Centers, SSI Professionals, and their affiliates’ businesses are independent, and are neither owned, operated, or controlled by SSI, and that while SSI establishes standards and materials for SSI training programs, it is not responsible for, nor does it have the right to control, the operation of the business activities or the day-to-day training programs and/or supervision of divers by SSI Training Centers, SSI Professionals, their affiliated businesses, and/or their associates’ staff. I further understand and agree on behalf of myself, that in the event of injury, illness or death during dive activities, I shall not hold SSI liable for the actions, inactions or negligence of the SSI Training Center, SSI Professionals, and other affiliated businesses or personnel associates with my dive activities.

I have read this Agreement and the SSI Introductory Scuba Code. I expressly understand my responsibilities and that I am giving up legal rights by signing this Agreement. I understand this is a legal contract and I am voluntarily signing it without inducement or duress. I understand this is an unconditional and complete release of all liability to the greatest extent allowed by law. If any portion of this Agreement is found to be legally unenforceable, that portion shall be severed, and the remainder shall have full legal force. I agree to be bound by this Agreement without modification of the preprinted text. I am over 18 years of age and legally competent to engage in this Agreement, or I have acquired the written consent of my parent or guardian by completing the SSI Youth Addendum form.

Today's date: December 7, 2022








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First Participant's Name

First Name*

Last Name*

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

To Aid in Equipment Selection:


Height *

Shoe size *
T-shirt size:*
First Participant's Signature*
Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
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City:*
State/Province:*
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Parent or Guardian's Email Address

Email*

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Emergency Contact's Name*

Emergency Contact's Phone Number*
Location
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Photo Release

I hereby authorize Diventures to publish photographs taken of me and/or the undersigned minor children, and/or names, for use in Diventures' marketing material, social media and website. I release Diventures from any expectation of confidentiality for the undersigned minor children and myself. I attest that I am the parent or legal guardian of the children listed below and that I have the authority to authorize Diventures to use their photographs and names.

I acknowledge that this photo participation is voluntary, and neither the minor children nor I will receive financial compensation. I further agree that our participation in any marketing piece produced by Diventures confers no rights of ownership whatsoever. I release Diventures, its contractors and its employees from liability for any claims by me or any third party in connection with my participation or the participation of the undersigned minor children.

Diver Medical Participant Questionnaire

Recreational scuba diving and freediving requires good physical and mental health. There are a few medical conditions which can be hazardous while diving, listed below. Those who have, or are predisposed to, any of these conditions, should be evaluated by a physician. This Diver Medical Participant Questionnaire provides a basis to determine if you should seek out that evaluation.

If you have any concerns about your diving fitness not represented on this form, consult with your physician before diving. If you are feeling ill, avoid diving. If you think you may have a contagious disease, protect yourself and others by not participating in dive training and/or dive activities. References to "diving" on this form encompass both recreational scuba diving and freediving.

This form is principally designed as an initial medical screen for new divers, but is also appropriate for divers taking continuing education. For your safety, and that of others who may dive with you, answer all questions honestly.

If you are pregnant, or attempting to become pregnant, do not dive.

I have or have had chest surgery, heart surgery, heart valve surgery, an implantable medical device (eg, stent, pacemaker, neurostimulator), pneumothorax, and/or chronic lung disease.*
I have or have had asthma, wheezing, severe allergies, hay fever or congested airways within the last 12 months that limits my physical activity/exercise.*
I have or have had a problem or illness involving my heart such as: angina, chest pain on exertion, heart failure, immersion pulmonary edema, heart attack or stroke, OR am taking medication for any heart condition.*
I have or have had recurrent bronchitis and currently coughing within the past 12 months, OR have been diagnosed with emphysema.*
I have or have had symptoms affecting my lungs, breathing, heart and/or blood in the last 30 days that impair my physical or mental performance.*
I am over 45 years of age AND I currently smoke or inhale nicotine by other means.*
I am over 45 years of age AND I have a high cholesterol level.*
I am over 45 years of age AND I have high blood pressure.*
I am over 45 years of age AND I have had a close blood relative die suddenly or of cardiac disease or stroke before the age of 50, OR have a family history of heart disease before age 50 (including abnormal heart rhythms, coronary artery disease or cardiomyopathy).*
I struggle to perform moderate exercise (for example, walk 1.6 kilometer/one mile in 14 minutes or swim 200 meters/yards without resting), OR I have been unable to participate in a normal physical activity due to fitness or health reasons within the past 12 months.*
I have or have had sinus surgery within the last 6 months.*
I have or have had ear disease or ear surgery, hearing loss, or problems with balance.*
I have or have had recurrent sinusitis within the past 12 months.*
I have or have had eye surgery within the past 3 months.*
I have had surgery within the last 12 months, OR I have ongoing problems related to past surgery.*
I have or have had a head injury with loss of consciousness within the past 5 years.*
I have or have had persistent neurologic injury or disease.*
I have or have had recurring migraine headaches within the past 12 months, or take medications to prevent them.*
I have or have had blackouts or fainting (full/partial loss of consciousness) within the last 5 years.*
I have or have had epilepsy, seizures, or convulsions, OR take medications to prevent them.*
I have or have had behavioral health, mental or psychological problems requiring medical/psychiatric treatment.*
I have or have had major depression, suicidal ideation, panic attacks, uncontrolled bipolar disorder requiring medication/psychiatric treatment.*
I have or have been diagnosed with a mental health condition or a learning/developmental disorder that requires ongoing care or special accommodation.*
I have or have had an addiction to drugs or alcohol requiring treatment within the last 5 years.*
I have or have had recurrent back problems in the last 6 months that limit my everyday activity.*
I have or have had back or spinal surgery within the last 12 months.*
I have or have had diabetes, drug or diet controlled, OR gestational diabetes within the last 12 months.*
I have or have had an uncorrected hernia that limits my physical abilities.*
I have or have had active or untreated ulcers, problem wounds, or ulcer surgery within the last 6 months.*
I have had ostomy surgery and do not have medical clearance to swim or engage in physical activity.*
I have had dehydration requiring medical intervention within the last 7 days.*
I have had active or untreated stomach or intestinal ulcers or ulcer surgery within the last 6 months.*
I have had frequent heartburn, regurgitation, or gastroesophageal reflux disease (GERD).*
I have had active or uncontrolled ulcerative colitis or Crohn's disease.*
I have had bariatric surgery within the last 12 months.*
I am taking prescription medications (with the exception of birth control or anti-malarial drugs other than mefloquine/Lariam).*

If you answered NO to all of the questions above, a medical evaluation is not required.

If you answered YES to a medical question above, please take the 'SSI Medical Form' found here:  https://www.diventures.com/forms to your physician for approval PRIOR TO class.

Participant Statement: I have answered all questions honestly, and understand that I accept responsibility for any consequences resulting from any questions I may have answered inaccurately or for my failure to disclose any existing or past health conditions.


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I understand that if I answered YES to any of the questions above, I will need medical clearance from a physician (must be either an MD or DO) prior to any training. That form can be found here: https://www.diventures.com/forms*

YOUTH ADDENDUM – INCORPORATED AS AN ADDENDUM TO THE ASSUMPTION OF RISK, LIABILITY RELEASE & HOLD HARMLESS AGREEMENT (Form not to be used within the European Union and various other countries depending on local laws/regulations - The Training Center and the Professionals are responsible to know and adhere to laws/local regulations) NOTICE TO THE MINOR CHILD’S NATURAL GUARDIAN 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 THE RELEASED PARTIES USE 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 AND THE ASSUMPTION OF RISK, LIABILITY RELEASE AND HOLD HARMLESS AGREEMENT. THIS YOUTH ADDENDUM TO THE ASSUMPTION OF RISK, LIABILITY RELEASE AND HOLD HARMLESS AGREEMENT IS VALID FOR ONE YEAR FROM THE DATE OF SIGNATURE.

Additionally, as the parent/guardian of the above named participant, I have read this document in its entirety prior to affixing my signature hereto. I have represented to Releasees that I have authority to sign this document on behalf of my minor child (the participant), myself and the other parent/guardian of said child. I agree, on behalf of myself, the other parent/guardian, and my minor child to be bound to all the terms and conditions of this Agreement. I understand all terms of this document, understand that I have given up and will continue to give up substantial rights by signing it, am aware of the document’s legal consequences, and have signed this document freely, voluntarily, and without any inducement, assurance or guarantee being made to me. I intend my signature to be a complete and unconditional release of all liability on behalf of myself, the other parent, and the participant to the greatest extent allowed by law and further agree to indemnify and hold harmless the above named Releasees from any and all liability and causes of action arising from the activities and actions described herein. I understand the risks of injury while swimming, scuba diving and/or snorkeling, and have had the opportunity to personally witness and fully discuss the activities or instructional program with a staff member prior to commencement of my minor child’s swimming, scuba diving and/or snorkeling activities.



By signing below the parent or court-appointed legal guardian agrees that they are also 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

To Aid in Equipment Selection:


Height *

Shoe size *
T-shirt size:*
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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