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The undersigned lessee acknowledges that they have examined and inspected the equipment leased and that it is in good condition in every respect, and agrees to return to the lessor at its premises in the same condition as received, less ordinary and normal wear and tear, and further agrees to pay such additional charge as may be made if not returned in clean condition. In the event the equipment is lost, damaged or destroyed under lease to him, lessee agrees to pay lessor all reasonable charges and costs thereof as lessor may impose. This AGREEMENT is a release of my rights and the rights of my heirs, assigns or beneficiaries to sue for injuries or death resulting from the rental and/or use of this equipment. I personally assume all risks of skin and/or scuba diving, whether foreseen or unforeseen, related in any way to the rental and/or use of this equipment. I understand and agree that PADI OR SDI Members (“Members”), including ANCHORS AWAY SCUBA and/or any individual PADI OR SDI Instructors and Divemasters associated with the program in which I am participating, are licensed to use various PADI OR SDI Trademarks and to conduct PADI OR SDI training, but are not agents, employees or franchisees of PADI OR SDI Americas, Inc, or its parent, subsidiary and affiliated corporations (“PADI OR SDI”). I further understand that Member business activities are independent, and are neither owned nor operated by PADI OR SDI, and that while PADI OR SDI establishes the standards for PADI OR SDI 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 OR SDI 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 OR SDI liable for the actions, inactions or negligence of ANCHORS AWAY SCUBA and/or the instructors and divemasters associated with the activity.


I understand and agree that ANCHORS AWAY SCUBA, and its employees, owners, officers, contractors, assigns or agents (hereinafter referred to as “Released Parties”), shall not be held liable or responsible in any way for any injury, death or other damages to me, my family, estate, heirs or assigns which may occur as a result of the rental and/or use of the equipment, or as a result of product defect, or the negligence of any party, including the Released Parties, whether passive or active.


I hereby acknowledge receipt of the equipment designated in this form, and, if any of this equipment is to be used for scuba diving I affirm I am a certified scuba diver or student diver in a scuba diving course/program under the supervision of a certified scuba instructor. 


I hereby acknowledge that as a certified diver or student under the supervision of a certified scuba instructor I will not provide any of this equipment to a non-certified diver. 


I affirm it is my responsibility to inspect all of the equipment and acknowledge it is in good working condition.  I affirm that it is my responsibility to check both the quality and quantity of gas in any scuba tanks.  I acknowledge 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 understand that skin diving and scuba diving are physically strenuous activities, that I will be exerting myself during these activities, 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 agree to reimburse the Dive Center/Resort for the loss or breakage of any and all equipment at the current replacement value and to also pay for damages incurred while transporting the equipment. I agree to return the equipment in clean condition and to pay a cleaning fee if not returned cleaned. 


I agree and understand that returning any or all of the equipment past the agreed upon date I will charged a full gear rental fee as a late fee per day the equipment is not returned and if I fail to return any or all of said gear that my credit card on file will be charged the full retail price of the gear. 


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 or 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 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, and beneficiaries may have to sue the Released Parties resulting from my death. I further represent I have the authority to do so and that my heirs, assigns, or beneficiaries will be estopped from claiming otherwise because of my representations to the Released Parties.


 Lessee further acknowledges that he has had proper instruction in the use of the equipment leased and is properly qualified to use said equipment and agrees to assume complete and sole responsibility for said use and forever hold lessor free and harmless for anything occurring as a result of said use. The undersigned further agrees to accept full responsibility for any injury either to themselves or to any other person and or for any damage to the property of themselves or other persons that may result through the use or misuse of the leased equipment, or in any manner whatsoever, from the time equipment leaves lessor's premises until it is returned thereto. Lessee further agrees that said equipment will not leased to no other person other than the undersigned lessee may use said equipment without first obtaining lessor's prior consent in writing. Lessee further agrees to keep said equipment from all encumbrances and for failure to do so or for default of any of the terms and conditions hereof, lessor may take immediate possession of said equipment whenever said equipment may be found, without being liable for trespass, and that such repossession shall not relive lessee of his liabilities under this agreement.


Lessee acknowledges that they have read the terms of this agreement and fully understands and consents to all of the provisions thereof. Lessee agrees that in the event any legal action is instituted against lessee under this agreement by lessor, they will pay reasonable attorney's fees and costs incurred in such action.


BY THIS INSTRUMENT AGREE TO EXEMPT AND RELEASE THE RELEASED PARTIES AND ALL RELATED ENTITIES AS DEFINED ABOVE, FROM ALL LIABILITY OR RESPONSIBILITY WHATSOEVER FOR PERSONAL INJURY, PROPERTY DAMAGE, OR WRONGFUL DEATH AS A RESULT OF RENTING AND/OR USING THE EQUIPMENT, HOWEVER CAUSED, INCLUDING BUT NOT LIMITED TO PRODUCT LIABILITY OR 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 ACKNOWLDGEMENT AGREEMENT AND LIABILITY RELEASE AND ASSUMPTION OF RISK AGREEMENT BY READING BOTH BEFORE SIGNING BELOW ON BEHALF OF MYSELF AND MY HEIRS.

First Lessee Name

First Name*

Middle Name

Last Name*

Phone*
First Lessee Date of Birth*
First Lessee Card on File

Card Number *

Exp Date: *

CV Code *

Zip Code *

I understand and authorize my card to be charged for additional late fees, lost or damage fees for the rental property I have received from the agency. I understand that my information will be saved to file for further transactions on my account. 

First Lessee Signature*
Second Lessee Name

First Name*

Middle Name

Last Name*
Second Lessee Date of Birth*
Second Lessee Card on File

Card Number *

Exp Date: *

CV Code *

Zip Code *

I understand and authorize my card to be charged for additional late fees, lost or damage fees for the rental property I have received from the agency. I understand that my information will be saved to file for further transactions on my account. 

Third Lessee Name

First Name*

Middle Name

Last Name*
Third Lessee Date of Birth*
Third Lessee Card on File

Card Number *

Exp Date: *

CV Code *

Zip Code *

I understand and authorize my card to be charged for additional late fees, lost or damage fees for the rental property I have received from the agency. I understand that my information will be saved to file for further transactions on my account. 

Fourth Lessee Name

First Name*

Middle Name

Last Name*
Fourth Lessee Date of Birth*
Fourth Lessee Card on File

Card Number *

Exp Date: *

CV Code *

Zip Code *

I understand and authorize my card to be charged for additional late fees, lost or damage fees for the rental property I have received from the agency. I understand that my information will be saved to file for further transactions on my account. 

Fifth Lessee Name

First Name*

Middle Name

Last Name*
Fifth Lessee Date of Birth*
Fifth Lessee Card on File

Card Number *

Exp Date: *

CV Code *

Zip Code *

I understand and authorize my card to be charged for additional late fees, lost or damage fees for the rental property I have received from the agency. I understand that my information will be saved to file for further transactions on my account. 

Sixth Lessee Name

First Name*

Middle Name

Last Name*
Sixth Lessee Date of Birth*
Sixth Lessee Card on File

Card Number *

Exp Date: *

CV Code *

Zip Code *

I understand and authorize my card to be charged for additional late fees, lost or damage fees for the rental property I have received from the agency. I understand that my information will be saved to file for further transactions on my account. 

Seventh Lessee Name

First Name*

Middle Name

Last Name*
Seventh Lessee Date of Birth*
Seventh Lessee Card on File

Card Number *

Exp Date: *

CV Code *

Zip Code *

I understand and authorize my card to be charged for additional late fees, lost or damage fees for the rental property I have received from the agency. I understand that my information will be saved to file for further transactions on my account. 

Eighth Lessee Name

First Name*

Middle Name

Last Name*
Eighth Lessee Date of Birth*
Eighth Lessee Card on File

Card Number *

Exp Date: *

CV Code *

Zip Code *

I understand and authorize my card to be charged for additional late fees, lost or damage fees for the rental property I have received from the agency. I understand that my information will be saved to file for further transactions on my account. 

Ninth Lessee Name

First Name*

Middle Name

Last Name*
Ninth Lessee Date of Birth*
Ninth Lessee Card on File

Card Number *

Exp Date: *

CV Code *

Zip Code *

I understand and authorize my card to be charged for additional late fees, lost or damage fees for the rental property I have received from the agency. I understand that my information will be saved to file for further transactions on my account. 

Tenth Lessee Name

First Name*

Middle Name

Last Name*
Tenth Lessee Date of Birth*
Tenth Lessee Card on File

Card Number *

Exp Date: *

CV Code *

Zip Code *

I understand and authorize my card to be charged for additional late fees, lost or damage fees for the rental property I have received from the agency. I understand that my information will be saved to file for further transactions on my account. 

Lessee Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:*
City:*
State/Province:*
Zip/Postal:*
Parent or Guardian's Email Address

Email*

Confirm Email*
Check to receive information, news, and discounts by e-mail.
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.


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*

Middle Name

Last Name*

Relationship*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Card on File

Card Number *

Exp Date: *

CV Code *

Zip Code *

I understand and authorize my card to be charged for additional late fees, lost or damage fees for the rental property I have received from the agency. I understand that my information will be saved to file for further transactions on my account. 

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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