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Cylinder Fill

 

Complete Liability Release, Assumption of Risk and Covenant Not to Sue

PLEASE READ THIS DOCUMENT CAREFULLY BEFORE SIGNING

The individual named below, including his/her family, heirs, successors and assigns, (hereinafter referred to as “I” or “me/my”) desires to purchase certain equipment from 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; DiVentures Virginia, LLC; and DiVentures Colorado Springs, LLC (collectively, “DiVentures Subsidiaries”) and their respective facilities, staff, officers, instructors, employees, agents, successors and assigns, (collectively, the “Releasees”). In consideration for being permitted to purchase a scuba compressed gas cylinder and/or to fill a high pressure gas cylinder for use (hereinafter "cylinder") from Releasees and in recognition of Releasees reliance hereon, I hereby expressly and contractually promise and agree to all terms and conditions set forth in this instrument (this “Release”) as follows:


I represent and warrant that:

  1. The cylinder will never be used by me for scuba diving;
  2. I will never allow the cylinder to be used for diving by anyone else; and
  3. I agree to have all tests, inspections, and routine maintenance performed on the cylinder in accordance with the manufacturer's specifications and industry (Compressed Gas Association (“CGA”)) standards.

 

I UNDERSTAND AND AM AWARE OF THE INHERENT DANGERS ASSOCIATED WITH THE PURCHASE, FILLING, HANDLING, USE, AND/OR STORAGE OF COMPRESSED AIR/GASSES AND THEIR CYLINDERS AND THE RISKS OF INJURY, DISABILITY, DEATH, AND/OR PROPERTY DAMAGE ARISING FROM OR RELATED TO ANY PURCHASE, FILL, OR USE OF SUCH COMPRESSED GAS CYLINDERS AND/OR HIGH PRESSURE GAS CYLINDERS. I ACKNOWLEDGE THAT ANY INJURIES I SUSTAIN FROM MY USE OF ANY SUCH CYLINDER MAY RESULT FROM OR BE COMPOUNDED BY THE ACTIONS, OMISSIONS, OR NEGLIGENCE OF DIVENTURES. NOTWITHSTANDING THESE RISKS, I ACKNOWLEDGE THAT I AM VOLUNTARILY ENTERING INTO THIS ARRANGEMENT FOR CYLINDER PURCHASE OR CYLINDER FILLING AND MY HANDLING, USE, AND/OR STORAGE OF SUCH CYLINDER WITH KNOWLEDGE OF THE DANGERS INVOLVED AND I HEREBY SPECIFICALLY ASSUME ANY AND ALL OF THOSE RISKS OF INJURY, DISABILITY, DEATH, AND/OR PROPERTY DAMAGE ARISING FROM MY PURCHASE, FILLING, AND/OR USE OF SUCH CYLINDER, WHETHER CAUSED BY THE NEGLIGENCE OF RELEASEES OR OTHERWISE.


I hereby expressly waive and release Releasees from any and all damages, losses, penalties, liabilities, costs, attorney’s fees, and expenses of any nature, and any demands, claims, and causes of action therefore, now known or herein after known, to me, for any and all liability arising as a consequence of any and all personal injury, disability, property damage, and/or death caused by or associated with the purchase or use of the cylinder, on behalf of myself and my heirs, and whether arising out of the negligence of Releasees or otherwise. I covenant not to make or bring any such claim against the Releasees, and forever release and discharge Releasees from any and all liability under any such claims.

 

I expressly agree to defend (at Diventures sole discretion), indemnify and hold harmless Releasees, against any and all losses, damages, liabilities, deficiencies, claims, actions, judgments, settlements, interests, awards, penalties, fines, costs, or expenses of whatever kind, including reasonable attorney’s fees, fees, the costs of enforcing any right to indemnification under this Release, and the cost of pursuing insurance providers, arising out of or resulting from any claim, including third party claims, for any personal injury, disability, property damage and/or death to myself or to others as a consequence of the my purchase or use of the cylinder, including any claim related to my own negligence or the negligence of Releasees.

 

I understand the purpose of signing this Release is to give up all my rights to sue, and that I am agreeing to release, forever discharge, and hold harmless Releasees, and that this document constitutes a legally binding contract. This Release constitutes the sole and entire agreement of Releasee and me with respect to the purchase and/or use of cylinders detailed herein and supersedes all prior and contemporaneous understandings, agreements, representations, and warranties, both written and oral with respect to the foregoing. This document is to be interpreted as broadly as possible, rather than narrowly construed, in the event of a legal dispute. If any term or provision of this Release is invalid, illegal, or unenforceable in any jurisdiction, such invalidity, illegality, or unenforceability shall not affect any other provision in any other jurisdiction. All matters arising out of or related to this Release shall be governed by and construed in accordance with the internal laws of the State in which the Releasee offering cylinder purchase or filling is located without effect to any choice of law provision or rule, and that State shall be the exclusive jurisdiction and venue of any legal action.

 

BY MY SIGNATURE BELOW, I ACKNOWLEDGE THAT I HAVE CAREFULLY READ AND UNDERSTAND THE FOREGOING IN ITS ENTIRETY AND AGREE TO THE TERMS AND CONDITIONS HEREINABOVE SET FORTH AND UNDERSTAND THIS RELEASE IS BINDING ON AND SHALL INURE TO THE BENEFIT OF RELEASEES AND ME, ON BEHALF OF MYSELF, MY HEIRS AND MY PERSONAL REPRESENTATIVE, AND EACH PARTY’S RESPECTIVE SUCCESSORS AND ASSIGNS. I HAVE HAD AN OPPORTUNITY TO ASK QUESTIONS REGARDING THIS DOCUMENT PRIOR TO SIGNING SAME.

 

This Release is effective as of the date of my signature.


Today's date: March 29, 2023




First Participant's Name

First Name*

Last Name*

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

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Last Name*
Second Participant's Date of Birth*
Third Participant's Name

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Third Participant's Date of Birth*
Fourth Participant's Name

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Fourth Participant's Date of Birth*
Fifth Participant's Name

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Fifth Participant's Date of Birth*
Sixth Participant's Name

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Sixth Participant's Date of Birth*
Seventh Participant's Name

First Name*

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Seventh Participant's Date of Birth*
Eighth Participant's Name

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Eighth Participant's Date of Birth*
Ninth Participant's Name

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Ninth Participant's Date of Birth*
Tenth Participant's Name

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Tenth Participant's Date of Birth*
Address
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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

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Parent or Guardian's Date of Birth*
Parent or Guardian's Signature*
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 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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