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516-997-4864   

www.scubadiversusa.com    


Today's Date: November 23, 2024

I am aware that Scuba Diving instruction and Diving are hazardous activities, and I am voluntarily participating in these activities with knowledge of the danger involved and hereby agree to accept any and all risks of injury or death. I further understand that by signing this document, I am releasing any claims which I may have against my Scuba Instructor/Tour leader, his/her assistants or against Scuba divers Inc. dba Scuba Network any of it’s employees, franchisees or affiliates as the Sponsor/Promoter of this trip from any liability for personal injury, property damage and/or wrongful death arising from my participating in the Scuba activities that I wish to engage in. I understand that diving with compressed air involves certain risks, and injury can occur which may require treatment in a recompression chamber. I further understand that the open water diving trips which are necessary for training and certification or pleasure may be conducted at a site that is remote, either by time or distance or both, from such a recompression chamber, and nonetheless agree to proceed with such dives. I hereby personally assume all risks in connection with said diving for any harm, injury, damage which may befall me as a result of my participating in diving, whether foreseen or unforeseen, and I still wish to proceed with diving in spite of the possible absence of recompression chamber in proximity to the dive site. I have read this form and fully understand that scuba is a dangerous sport and that signing this form, I am giving up any legal rights that I have.

 

 -A valid passport is required for most travel. Responsibility for travel documents is accepted by traveler.


First Participant's Name

First Name*

Last Name*

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

Trip Cancellation/Interruption Insurance is highly recommended. The main feature of this insurance provides coverage of the insured is prevented from taking his/her prearranged tour due to either injury, sickness or airline default.


NO, I decline trip Interruption Insurance. AND ASSUME ALL FINANCIAL RESPONSIBILITY.
YES, I'd like to purchase insurance, and I will notify scuba network of the insurance information.

I authorize Scuba Network to bill the charge(s) to my credit card(s) for the services and amounts outlined above and I hereby agree to the cancellation policy and accept the diving waiver described above.



Name as it appears on CC:

Click to customize date box label

TERMS OF CANCELLATION:

Scuba excursions are highly specialized trips that must be planned and prepared well in advance. As a result, penalties for cancellation are severe regardless of reason.

  -ALL PAYMENTS RECEIVED ARE NOT REFUNDABLE

First Participant's Signature*
Second Participant's Name

First Name*

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

Trip Cancellation/Interruption Insurance is highly recommended. The main feature of this insurance provides coverage of the insured is prevented from taking his/her prearranged tour due to either injury, sickness or airline default.


NO, I decline trip Interruption Insurance. AND ASSUME ALL FINANCIAL RESPONSIBILITY.
YES, I'd like to purchase insurance, and I will notify scuba network of the insurance information.

I authorize Scuba Network to bill the charge(s) to my credit card(s) for the services and amounts outlined above and I hereby agree to the cancellation policy and accept the diving waiver described above.



Name as it appears on CC:

Click to customize date box label

TERMS OF CANCELLATION:

Scuba excursions are highly specialized trips that must be planned and prepared well in advance. As a result, penalties for cancellation are severe regardless of reason.

  -ALL PAYMENTS RECEIVED ARE NOT REFUNDABLE

Third Participant's Name

First Name*

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

Trip Cancellation/Interruption Insurance is highly recommended. The main feature of this insurance provides coverage of the insured is prevented from taking his/her prearranged tour due to either injury, sickness or airline default.


NO, I decline trip Interruption Insurance. AND ASSUME ALL FINANCIAL RESPONSIBILITY.
YES, I'd like to purchase insurance, and I will notify scuba network of the insurance information.

I authorize Scuba Network to bill the charge(s) to my credit card(s) for the services and amounts outlined above and I hereby agree to the cancellation policy and accept the diving waiver described above.



Name as it appears on CC:

Click to customize date box label

TERMS OF CANCELLATION:

Scuba excursions are highly specialized trips that must be planned and prepared well in advance. As a result, penalties for cancellation are severe regardless of reason.

  -ALL PAYMENTS RECEIVED ARE NOT REFUNDABLE

Fourth Participant's Name

First Name*

Last Name*
Fourth Participant's Date of Birth*
Fourth Participant's Information

Trip Cancellation/Interruption Insurance is highly recommended. The main feature of this insurance provides coverage of the insured is prevented from taking his/her prearranged tour due to either injury, sickness or airline default.


NO, I decline trip Interruption Insurance. AND ASSUME ALL FINANCIAL RESPONSIBILITY.
YES, I'd like to purchase insurance, and I will notify scuba network of the insurance information.

I authorize Scuba Network to bill the charge(s) to my credit card(s) for the services and amounts outlined above and I hereby agree to the cancellation policy and accept the diving waiver described above.



Name as it appears on CC:

Click to customize date box label

TERMS OF CANCELLATION:

Scuba excursions are highly specialized trips that must be planned and prepared well in advance. As a result, penalties for cancellation are severe regardless of reason.

  -ALL PAYMENTS RECEIVED ARE NOT REFUNDABLE

Fifth Participant's Name

First Name*

Last Name*
Fifth Participant's Date of Birth*
Fifth Participant's Information

Trip Cancellation/Interruption Insurance is highly recommended. The main feature of this insurance provides coverage of the insured is prevented from taking his/her prearranged tour due to either injury, sickness or airline default.


NO, I decline trip Interruption Insurance. AND ASSUME ALL FINANCIAL RESPONSIBILITY.
YES, I'd like to purchase insurance, and I will notify scuba network of the insurance information.

I authorize Scuba Network to bill the charge(s) to my credit card(s) for the services and amounts outlined above and I hereby agree to the cancellation policy and accept the diving waiver described above.



Name as it appears on CC:

Click to customize date box label

TERMS OF CANCELLATION:

Scuba excursions are highly specialized trips that must be planned and prepared well in advance. As a result, penalties for cancellation are severe regardless of reason.

  -ALL PAYMENTS RECEIVED ARE NOT REFUNDABLE

Sixth Participant's Name

First Name*

Last Name*
Sixth Participant's Date of Birth*
Sixth Participant's Information

Trip Cancellation/Interruption Insurance is highly recommended. The main feature of this insurance provides coverage of the insured is prevented from taking his/her prearranged tour due to either injury, sickness or airline default.


NO, I decline trip Interruption Insurance. AND ASSUME ALL FINANCIAL RESPONSIBILITY.
YES, I'd like to purchase insurance, and I will notify scuba network of the insurance information.

I authorize Scuba Network to bill the charge(s) to my credit card(s) for the services and amounts outlined above and I hereby agree to the cancellation policy and accept the diving waiver described above.



Name as it appears on CC:

Click to customize date box label

TERMS OF CANCELLATION:

Scuba excursions are highly specialized trips that must be planned and prepared well in advance. As a result, penalties for cancellation are severe regardless of reason.

  -ALL PAYMENTS RECEIVED ARE NOT REFUNDABLE

Seventh Participant's Name

First Name*

Last Name*
Seventh Participant's Date of Birth*
Seventh Participant's Information

Trip Cancellation/Interruption Insurance is highly recommended. The main feature of this insurance provides coverage of the insured is prevented from taking his/her prearranged tour due to either injury, sickness or airline default.


NO, I decline trip Interruption Insurance. AND ASSUME ALL FINANCIAL RESPONSIBILITY.
YES, I'd like to purchase insurance, and I will notify scuba network of the insurance information.

I authorize Scuba Network to bill the charge(s) to my credit card(s) for the services and amounts outlined above and I hereby agree to the cancellation policy and accept the diving waiver described above.



Name as it appears on CC:

Click to customize date box label

TERMS OF CANCELLATION:

Scuba excursions are highly specialized trips that must be planned and prepared well in advance. As a result, penalties for cancellation are severe regardless of reason.

  -ALL PAYMENTS RECEIVED ARE NOT REFUNDABLE

Eighth Participant's Name

First Name*

Last Name*
Eighth Participant's Date of Birth*
Eighth Participant's Information

Trip Cancellation/Interruption Insurance is highly recommended. The main feature of this insurance provides coverage of the insured is prevented from taking his/her prearranged tour due to either injury, sickness or airline default.


NO, I decline trip Interruption Insurance. AND ASSUME ALL FINANCIAL RESPONSIBILITY.
YES, I'd like to purchase insurance, and I will notify scuba network of the insurance information.

I authorize Scuba Network to bill the charge(s) to my credit card(s) for the services and amounts outlined above and I hereby agree to the cancellation policy and accept the diving waiver described above.



Name as it appears on CC:

Click to customize date box label

TERMS OF CANCELLATION:

Scuba excursions are highly specialized trips that must be planned and prepared well in advance. As a result, penalties for cancellation are severe regardless of reason.

  -ALL PAYMENTS RECEIVED ARE NOT REFUNDABLE

Ninth Participant's Name

First Name*

Last Name*
Ninth Participant's Date of Birth*
Ninth Participant's Information

Trip Cancellation/Interruption Insurance is highly recommended. The main feature of this insurance provides coverage of the insured is prevented from taking his/her prearranged tour due to either injury, sickness or airline default.


NO, I decline trip Interruption Insurance. AND ASSUME ALL FINANCIAL RESPONSIBILITY.
YES, I'd like to purchase insurance, and I will notify scuba network of the insurance information.

I authorize Scuba Network to bill the charge(s) to my credit card(s) for the services and amounts outlined above and I hereby agree to the cancellation policy and accept the diving waiver described above.



Name as it appears on CC:

Click to customize date box label

TERMS OF CANCELLATION:

Scuba excursions are highly specialized trips that must be planned and prepared well in advance. As a result, penalties for cancellation are severe regardless of reason.

  -ALL PAYMENTS RECEIVED ARE NOT REFUNDABLE

Tenth Participant's Name

First Name*

Last Name*
Tenth Participant's Date of Birth*
Tenth Participant's Information

Trip Cancellation/Interruption Insurance is highly recommended. The main feature of this insurance provides coverage of the insured is prevented from taking his/her prearranged tour due to either injury, sickness or airline default.


NO, I decline trip Interruption Insurance. AND ASSUME ALL FINANCIAL RESPONSIBILITY.
YES, I'd like to purchase insurance, and I will notify scuba network of the insurance information.

I authorize Scuba Network to bill the charge(s) to my credit card(s) for the services and amounts outlined above and I hereby agree to the cancellation policy and accept the diving waiver described above.



Name as it appears on CC:

Click to customize date box label

TERMS OF CANCELLATION:

Scuba excursions are highly specialized trips that must be planned and prepared well in advance. As a result, penalties for cancellation are severe regardless of reason.

  -ALL PAYMENTS RECEIVED ARE NOT REFUNDABLE

Participant's 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*
TRAVEL RECEIPT

PKG. PRICE: *

EXTRAS: *

TOTAL: *

# NIGHTS: *

HOTEL: *

DESTINATION: *

Arrival Date: *

Departure Date: *

PASSPORT NUMBER: *

EXPIRATION DATE: *

Date of Birth: *

HOME #:

CELL #: *
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*

Last Name*

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

Trip Cancellation/Interruption Insurance is highly recommended. The main feature of this insurance provides coverage of the insured is prevented from taking his/her prearranged tour due to either injury, sickness or airline default.


NO, I decline trip Interruption Insurance. AND ASSUME ALL FINANCIAL RESPONSIBILITY.
YES, I'd like to purchase insurance, and I will notify scuba network of the insurance information.

I authorize Scuba Network to bill the charge(s) to my credit card(s) for the services and amounts outlined above and I hereby agree to the cancellation policy and accept the diving waiver described above.



Name as it appears on CC:

Click to customize date box label

TERMS OF CANCELLATION:

Scuba excursions are highly specialized trips that must be planned and prepared well in advance. As a result, penalties for cancellation are severe regardless of reason.

  -ALL PAYMENTS RECEIVED ARE NOT REFUNDABLE

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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