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´╗┐Fill out the waiver for your FIRST dive of the day scheduled ASAP.

Liability Release for Certified Diver or Snorkeler



This Is A Release Of Your Rights to sue In2Scuba Diving Maui LLC. its owners or Tyrone Burnett, Employees, Agents, Affiliates, Contractors. State of Hawaii, County of Maui, Dept. of Land and Natural Resources, Owners of, and managers of land, and the facilities used. And assigns For Personal Injuries Or Wrongful Death That May Occur During The Forthcoming Dive Activity As A Result Of The Inherent Risk Associated with Scuba Diving Or As The Result Of Negligence. 

Place your initials next to each of the following sections

(1) I acknowledge that I am a certified scuba diver trained in safe diving practices.

(2) I am aware of the inherent risks of this sport, including danger of injury inflicted by marine animals living in a wild environment. 

(3) I affirm that I am in good mental and physical fitness for diving and that I am not under the influence of alcohol, Nor am I under the influence of any drugs that are contradictory to scuba diving. If I am taking any medication, I affirm that I have seen a physician and have approval to dive while under the influence of this medication. 

(4) I am aware of the dangers of breath holding while scuba diving and will not Hold In2Scuba Diving Maui or Tyrone Burnett and related entities (such as owners, employees, dive masters, contractors, booking agents, diver training agencies or any other affiliates) responsible if I am injured doing so. 

(5) I am aware that it is my responsibility to monitor my own air pressure, depth and time and to keep myself within safe diving limits appropriate to my skill level and ocean conditions. I will not hold In2Scuba Diving Maui or Tyrone Burnett and related entities responsible for any failure on my part to observe safe diving practices which lead to injury. 

(6) I will inspect all of my equipment prior to the activity and will notify personnel if any of my equipment (or equipment I am renting) is not working properly. I will not hold not In2Scuba Diving Maui or Tyrone Burnett and related entities responsible for my failure to inspect my equipment prior to diving or snorkeling 

(7) I acknowledge that I am physically fit to scuba dive/snorkel and will not hold the above listed individuals or company responsible if I am injured as a result heart, lung ear, or circulatory problems or other illness that occur while (or due to) scuba diving or snorkeling. 

(8) I understand that even though I follow the appropriate dive practices, there is still some risk of me sustaining decompression sickness, embolism or other hyper-baric injuries, and expressly assume the risk of said injuries. 

(9) I also expressly assume the risk and accept all responsibility to plan my dive and dive my plan. 

(10) I understand that scuba diving/snorkeling is a physically strenuous activity and that I will be exerting myself during this diving activity, and that if I am injured as a result of a heart attack, panic, hyperventilation, etc.. I expressly assume the risk of said injuries and will not hold the above listed individuals responsible for the same 

(11) I understand that on this open-water diving activity I will be at a remote location and there will not be immediate medical care or hyper-baric care available to me and I expressly assume the risk of diving in such a remote location. 

(12) I am aware of the danger of going to altitude via helicopter, plane, car within a 12-24 hour period, and will follow current recommendations and safe diving practices. 

It is the intention of the undersigned By This Instrument To Release In2Scuba Diving Maui or Tyrone Burnett And Its owners, Employees and All Related Entities as Defined above from All Liability Whatsoever for Personal Injury, Property Damage, Or Wrongful Death Caused by Negligence. I Have Informed Myself Of The Contents Of This Information And Release By Reading It Before I Signed It On Behalf Of Myself Or My Heirs.

Today's Date: September 29, 2023 



First Diver's Name

First Name*

Middle Name

Last Name*
First Diver's Date of Birth*
I certify that I am 18 years of age or older
First Diver's Information

Certification Agency Card Number *
First Diver's Signature*
Second Diver's Name

First Name*

Middle Name

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

Certification Agency Card Number *
Third Diver's Name

First Name*

Middle Name

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

Certification Agency Card Number *
Fourth Diver's Name

First Name*

Middle Name

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

Certification Agency Card Number *
Fifth Diver's Name

First Name*

Middle Name

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

Certification Agency Card Number *
Sixth Diver's Name

First Name*

Middle Name

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

Certification Agency Card Number *
Seventh Diver's Name

First Name*

Middle Name

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

Certification Agency Card Number *
Eighth Diver's Name

First Name*

Middle Name

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

Certification Agency Card Number *
Ninth Diver's Name

First Name*

Middle Name

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

Certification Agency Card Number *
Tenth Diver's Name

First Name*

Middle Name

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

Certification Agency Card Number *
Parent or Guardian's Email Address

Email*

Confirm Email*
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Emergency Contact

First Name*

Last Name*

Emergency Contact's Phone Number*

Emergency Contact's Relation to Participant
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*
Parent or Guardian's Date of Birth*
I certify that I am 18 years of age or older
Parent or Guardian's Information

Certification Agency Card Number *
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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