Loading...

EXPRESS ASSUMPTION OF RISK ASSOCIATED WITH SNORKELING, APNEA DIVING, SCUBA DIVING, FIRST AID, AND RELATED ACTIVITIES

I, 

 hereby affirm and acknowledge that I have been fully informed of the inherent hazards and risks associated with Snorkeling, Apnea Diving, SCUBA Diving, First Aid, and instruction related thereto (“Diving Activities”). I fully understand that these hazards and risks can lead to severe injury and even loss of life. I understand that Snorkeling, Apnea Diving, SCUBA Diving, and First Aid actives may be conducted at a site that is remote from a recompression chamber and competent medical assistance. Nevertheless, I choose to proceed even in the absence of a recompression chamber and competent medical assistance. Additionally, I understand that there are also hazards and risks associated with Snorkeling, Apnea Diving, SCUBA Diving, First Aid, and related travel, including, but not limited to the possible injury or loss of life as a result of a vessel accident, being hit by a vessel while in or under the water, while boarding, disembarking, exiting and/or reboarding the vessel to begin or end diving actives, equipment failure, user error, as well as during travel to and from dive sites. Despite the potential hazards and risks associated with Snorkeling, Apnea Diving SCUBA Diving, First Aid actives, and related actives which can include but are not limited to, aquatic life encounters, currents, waves, barotraumas (pressure change related injuries), sudden loss of visibility, entrapment underwater in wrecks, caves, vegetation, fishing line, fishing nets or debris, I wish to proceed and I freely accept and expressly assume all hazards and risks, that may arise from Snorkeling, Apnea Diving, SCUBA Diving, First Aid actives, and related actives which could result in personal injury, loss of life and property damage to me. 


RELEASE OF LIABILITY AND WAIVER OF CLAIMS AGREEMENT:

In consideration of being allowed to participate in Snorkeling, Apnea Diving, SCUBA Diving, and First Aid activities as well as the use of any of the facilities and the use of the equipment of the below listed persons or entities, I hereby agree as follows:

1. TO WAIVE AND RELEASE ANY AND ALL CLAIMS based upon negligence, active or passive with the exception of intentional, wanton or willful misconduct that I may have in the future against any of the following named persons or entities (hereinafter referred to as Releasees); National Association of Underwater Instructors, Inc. (NAUI) and subsidiary companies:

(Instructor/s and Leader/s) Peter Lloyd, Matt Ortleva, Leon Ostrowski, Tom Bieli, Dan Daily, Joe Shiber, Nicholas Bosshardt 

(Facility/ies) Streamline Diving                                                                           

(Others)                                                                                                                

2. To release the Releasees, their officers, directors, employees, representatives, agents and volunteers, from liability and responsibility, whatsoever, for any claims or causes of action that I, my estate, heirs, executors or assigns may have for personal injury, property damage or wrongful death arising from Snorkeling, Apnea Diving, SCUBA Diving, First Aid activities, and related activities whether caused by active or passive negligence of the Releasees or otherwise with the exception of gross negligence. By executing this Agreement, I agree to hold the Releasees harmless for any injury or loss of life which may occur to me during Snorkeling, Apnea Diving, SCUBA Diving, and First Aid activities and/or instruction, and any and all future courses of instruction, programs and Snorkeling, Apnea Diving, SCUBA Diving, and First Aid related travel I undertake.

3. I fully understand that Snorkeling, Apnea Diving, SCUBA Diving, and First Aid related actives are physically strenuous and I will be exerting myself during this course of instruction. I understand and agree that if I am injured or killed as a result of heart attack, panic, hyperventilation, oxygen toxicity, hypoxia, narcosis, aquic life encounters, drowning or any other cause, that I expressly assume the risk of these injuries and/or attended death and that I will not hold the Releasees included in this Agreement responsible in any other way.

4. By entering into this Agreement, I am not relying on any oral or written representation or statements made by the Releasees, other than what is set forth in this Agreement. I further agree that this Agreement shall be governed by and interpreted in accordance with the laws of the State of Florida, United States of America.

5. If any provision, section, subsection, clause or phrase of this Agreement is found to be unenforceable or invalid, that portion shall be severed from this Agreement. The remainder of this Agreement will then be construed as though the unenforceable portion had never been contained in the Agreement. The English language version of this document shall be controlling in all respects and shall prevail in case of any inconsistencies with translated versions.

I fully understand that the terms of this Agreement are contractual in nature and not a mere recital. I further state by way of my signature I have signed this Agreement of my own free act. I hereby declare that I am of legal age and am competent to sign this Agreement or, if not, that my parent or legal guardian shall sign on my behalf, and that my parent or legal guardian is in complete understanding and concurrence with this Agreement.

I HAVE READ THIS AGREEMENT, I UNDERSTAND IT, I AGREE TO BE BOUND BY IT.

Signature of Participant: 

Date:April 27, 2024

Witness: Streamline Diving      

Witness Signature: (Picture will be taken on streamline Kiosk for this waiver or a email verification will be sent as witness) 

Signature of Parent OR Guardian If Participant Is a Minor, and by their signature they, on my behalf release all claims that both they and I have. (Parent or Guardian Signature will be completed later in this wavier)

INSTRUCTOR/LEADER CONFIRMATION

STREAMLINE DIVING WILL REVIEWE THIS AGREEMENT AND CONFIRM THAT IT HAS BEEN PROPERLY COMPLETED.



Liability Release and Assumption of Risk Equipment Rental Agreement

This AGREEMENT is entered into between STREAMLINE DIVING DIVE CENTER and myself the lessee , for the rental of scuba and/or skin diving equipment. This AGREEMENT is a release of my rights to sue for injuries or death resulting from the rental and/or use of this equipment. I expressly assume all risks of skin and/or scuba diving related in any way to the rental and/or use of this equipment.

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

I acknowledge that the equipment is in good working condition and that I have examined the equipment to ensure that it is free from defects, including checking both the quality and quantity of gas in any scuba tank(s) rented. I also agree and understand that STREAMLINE DIVING DIVE CENTER and its employees, owners, officers, or agents (hereinafter "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 agree to reimburse STREAMLINE DIVING DIVE CENTER for the loss or breakage of any and all equipment at the current replacement value and 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 further state that I am of lawful age and legally competent to sign this liability release, or that I have acquired the written consent of my parents(s) or guardian(s). I understand the terms herein are contractual and not a mere recital, and that I have signed this document 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 through 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, or 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 stopped from claiming otherwise because of my representations to the Released Parties.

I the 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.

I HAVE CAREFULLY READ AND UNDERSTAND THE ABOVE AGREEMENT. BY SIGNING THIS AGREEMENT, I 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 RELEASE PARTIES, WHETHER PASSIVE OR ACTIVE.

I have fully informed myself and my heirs of the contents of this Liability Release and Assumption of Risk

Agreement by reading it before I signed it on behalf of myself and my heirs.


STUDENT'S AGREED RESPONSIBILITIES OF COURSE

The student agrees to study independently as specified by the instructor. In general, this means that before each class session, the student will:

     1.Watch the appropriate assigned portion(s) of the course video(s). 

     2.Read the appropriate assigned section(s) of the course manual(s), and complete the exercise questions within. 

     3.Complete the appropriate Knowledge Review(s) to be handed in at the start of class each day.

In addition, the student agrees to:

     1.Follow all course procedures as set forth by the instructor.

     2.Ask questions about any class-related items not understood.

     3.Show up for all sessions on time and prepared.

If the student arrives at class, but has failed to complete and turn in assigned work, or if the student fails to arrive on time, it may be necessary to make up the work and continue the class at a later date. The student will be responsible for any additional costs and/or inconvenience this may cause. In scheduling and determining additional costs, Streamline Diving will give every reasonable consideration to unforeseen events, such as family emergencies, that led to this situation.


INSTRUCTOR/STAFF RESPONSIBILITIES

The course instructor(s) and staff agree to:

     1.Be ready to begin the course as scheduled.

     2.Provide a positive learning environment in which to master the course objectives.

     3.Answer the students questions to the best of their ability.

     4.Assist the student through learning challenges.

  • If the student completes all course work as assigned, arrives for class promptly, and otherwise follows directions for learning as given by the instructor(s), Streamline Diving will accept responsibility for reasonable learning challenges. Course objectives must be met before certification before the student is certified, but in this situation Streamline Diving will schedule any necessary training sessions, at no additional charge to the student, until either (A) the student masters the course objectives, or, (B) the student voluntarily withdraws.
  • Fees may accrue If the student cannot follow Streamline Diving planed schedules which may occur additional expenses like pool rentals, instructor fees, etc.


GENERAL TERMS AND CONDITIONS:

     1. Your non-refundable 25% deposit reserves your place in the above course.

     2. Balance of course fee is due by the first class meeting.

     3. Our policy on drugs and alcohol is simple - ZERO TOLERANCE.

     4. Candidates are expected to furnish their own equipment for use during the program. Rental equipment is available upon request at a special student rate for currently enrolled students in good standing. The rental equipment is included in the NAUI Scuba Diver or PADI OW programs but does not include Mask Snorkel, Fins or Boots.

     5. Course books, education supplies, fees, travel expenses, etc, if any, are not included in your course fee. However, recreational certification fees are included in all recreational-level courses. Also, the course may include eLearning, Crew Pack, Student Video, and Student Protection Plan.

 I HAVE READ THIS AGREEMENT, I UNDERSTAND IT, I AGREE TO BE BOUND BY IT.

Please select who will be participating...
AdultMinor
Continue
First Participant's Name

First Name*

Middle Name

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

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 ftness 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.



Directions

Complete this questionnaire as a prerequisite to a recreational scuba diving or freediving course.

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


1. I have had problems with my lungs, breathing, heart and/or blood affecting my normal physical or mental performance.*
Yes -Complete Box A Below
No
2. I am over 45 years of age.*
Yes - Complete Box B Below
No
3. 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.*
Yes **
No
4. I have had problems with my eyes, ears, or nasal passages/sinuses.*
Yes - Complete Box C Below
No
5. I have had surgery within the last 12 months, OR I have ongoing problems related to past surgery.*
Yes **
No
6. I have lost consciousness, had migraine headaches, seizures, stroke, significant head injury, or suffer from persistent neurologic injury or disease.*
Yes - Complete Box D Below
No
7. I am currently undergoing treatment (or have required treatment within the last five years) for psychological problems, personality disorder, panic attacks, or an addiction to drugs or alcohol; or, I have been diagnosed with a learning disability.*
Yes - Complete Box E Below
No
8. I have had back problems, hernia, ulcers, or diabetes.*
Yes - Complete Box F Below
No
9. I have had stomach or intestine problems, including recent diarrhea.*
Yes - Complete Box G Below
No
10. I am taking prescription medications (with the exception of birth control or anti-malarial drugs other than mefloquine/Lariam).*
Yes **
No

__________________________________________________________________________

If you answered NO to all 10 questions above, the medical evaluation (Boxes A to G) below is not required. Please read and agree to the participant statement below by signing.

__________________________________________________________________________






Please answer ALL the below questions if you answered YES to number(s) 3,5,& 10 above.

Diver Medical | Participant Questionnaire Continued


__________________________________________________________________________

Box A - I have/have had:

__________________________________________________________________________


Chest surgery, heart surgery, heart valve surgery, stent placement, or a pneumothorax (collapsed lung).*
Yes
No
Asthma, wheezing, severe allergies, hay fever or congested airways within the last 12 months that limits my physical activity/exercise.*
Yes
No
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.*
Yes
No
Recurrent bronchitis and currently coughing within the past 12 months, OR have been diagnosed with emphysema.*
Yes
No
A diagnosis of COVID-19.*
Yes
No

__________________________________________________________________________

Box B - I am over 45 years of age AND:

__________________________________________________________________________

I currently smoke or inhale nicotine by other means.*
Yes
No
I have a high cholesterol level.*
Yes
No
I have high blood pressure.*
Yes
No
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).*
Yes
No

__________________________________________________________________________

Box C - I have/have had:

__________________________________________________________________________

Sinus surgery within the last 6 months.*
Yes
No
Ear disease or ear surgery, hearing loss, or problems with balance.*
Yes
No
Recurrent sinusitis within the past 12 months.*
Yes
No
Eye surgery within the past 3 months.*
Yes
No

__________________________________________________________________________

Box D - I have/have had:

__________________________________________________________________________

Head injury with loss of consciousness within the past 5 years.*
Yes
No
Persistent neurologic injury or disease.*
Yes
No
Recurring migraine headaches within the past 12 months, or take medications to prevent them.*
Yes
No
Blackouts or fainting (full/partial loss of consciousness) within the last 5 years.*
Yes
No
Epilepsy, seizures, or convulsions, OR take medications to prevent them.*
Yes
No

__________________________________________________________________________

Box E - I have/have had:

__________________________________________________________________________

Behavioral health, mental or psychological problems requiring medical/psychiatric treatment.*
Yes
No
Major depression, suicidal ideation, panic attacks, uncontrolled bipolar disorder requiring medication/psychiatric treatment.*
Yes
No
Been diagnosed with a mental health condition or a learning/developmental disorder that requires ongoing care.*
Yes
No
An addiction to drugs or alcohol requiring treatment within the last 5 years.*
Yes
No

__________________________________________________________________________

Box F - I have/have had:

__________________________________________________________________________

Recurrent back problems in the last 6 months that limit my everyday activity.*
Yes
No
Back or spinal surgery within the last 12 months.*
Yes
No
Diabetes, either insulin- or diet-controlled, OR gestational diabetes within the last 12 months.*
Yes
No
An uncorrected hernia that limits my physical abilities.*
Yes
No
Active or untreated ulcers, problem wounds, or ulcer surgery within the last 6 months.*
Yes
No

__________________________________________________________________________

Box G - I have had:

__________________________________________________________________________

Ostomy surgery and do not have medical clearance to swim or engage in physical activity.*
Yes
No
Dehydration requiring medical intervention within the last 7 days.*
Yes
No
Active or untreated stomach or intestinal ulcers or ulcer surgery within the last 6 months.*
Yes
No
Frequent heartburn, regurgitation, or gastroesophageal reflux disease (GERD).*
Yes
No
Active or uncontrolled ulcerative colitis or Crohn's disease.*
Yes
No
Bariatric surgery within the last 12 months.*
Yes
No

__________________________________________________________________________

* If you answered YES to questions 3, 5 or 10 above OR to any of the questions on Boxes A,B,C,D,E,F or G , please read and agree to the statement above by signing AND complete the Medical Form with your physician from our website or download the Medical Form below from the link provided. Take all three pages of the form (Participant Questionnaire and the Physician's Evaluation Form) to your physician for a medical evaluation.


Participation in a diving course requires your physician's approval.

To print a physical form for your physican please print this Medical Form 

__________________________________________________________________________




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.

First Participant's Signature*
Parent or Guardian's Email Address

Email*

Confirm Email*
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(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*
Parent or Guardian's Date of Birth*
Parent or Guardian's Information

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 ftness 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.



Directions

Complete this questionnaire as a prerequisite to a recreational scuba diving or freediving course.

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


1. I have had problems with my lungs, breathing, heart and/or blood affecting my normal physical or mental performance.*
Yes -Complete Box A Below
No
2. I am over 45 years of age.*
Yes - Complete Box B Below
No
3. 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.*
Yes **
No
4. I have had problems with my eyes, ears, or nasal passages/sinuses.*
Yes - Complete Box C Below
No
5. I have had surgery within the last 12 months, OR I have ongoing problems related to past surgery.*
Yes **
No
6. I have lost consciousness, had migraine headaches, seizures, stroke, significant head injury, or suffer from persistent neurologic injury or disease.*
Yes - Complete Box D Below
No
7. I am currently undergoing treatment (or have required treatment within the last five years) for psychological problems, personality disorder, panic attacks, or an addiction to drugs or alcohol; or, I have been diagnosed with a learning disability.*
Yes - Complete Box E Below
No
8. I have had back problems, hernia, ulcers, or diabetes.*
Yes - Complete Box F Below
No
9. I have had stomach or intestine problems, including recent diarrhea.*
Yes - Complete Box G Below
No
10. I am taking prescription medications (with the exception of birth control or anti-malarial drugs other than mefloquine/Lariam).*
Yes **
No

__________________________________________________________________________

If you answered NO to all 10 questions above, the medical evaluation (Boxes A to G) below is not required. Please read and agree to the participant statement below by signing.

__________________________________________________________________________






Please answer ALL the below questions if you answered YES to number(s) 3,5,& 10 above.

Diver Medical | Participant Questionnaire Continued


__________________________________________________________________________

Box A - I have/have had:

__________________________________________________________________________


Chest surgery, heart surgery, heart valve surgery, stent placement, or a pneumothorax (collapsed lung).*
Yes
No
Asthma, wheezing, severe allergies, hay fever or congested airways within the last 12 months that limits my physical activity/exercise.*
Yes
No
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.*
Yes
No
Recurrent bronchitis and currently coughing within the past 12 months, OR have been diagnosed with emphysema.*
Yes
No
A diagnosis of COVID-19.*
Yes
No

__________________________________________________________________________

Box B - I am over 45 years of age AND:

__________________________________________________________________________

I currently smoke or inhale nicotine by other means.*
Yes
No
I have a high cholesterol level.*
Yes
No
I have high blood pressure.*
Yes
No
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).*
Yes
No

__________________________________________________________________________

Box C - I have/have had:

__________________________________________________________________________

Sinus surgery within the last 6 months.*
Yes
No
Ear disease or ear surgery, hearing loss, or problems with balance.*
Yes
No
Recurrent sinusitis within the past 12 months.*
Yes
No
Eye surgery within the past 3 months.*
Yes
No

__________________________________________________________________________

Box D - I have/have had:

__________________________________________________________________________

Head injury with loss of consciousness within the past 5 years.*
Yes
No
Persistent neurologic injury or disease.*
Yes
No
Recurring migraine headaches within the past 12 months, or take medications to prevent them.*
Yes
No
Blackouts or fainting (full/partial loss of consciousness) within the last 5 years.*
Yes
No
Epilepsy, seizures, or convulsions, OR take medications to prevent them.*
Yes
No

__________________________________________________________________________

Box E - I have/have had:

__________________________________________________________________________

Behavioral health, mental or psychological problems requiring medical/psychiatric treatment.*
Yes
No
Major depression, suicidal ideation, panic attacks, uncontrolled bipolar disorder requiring medication/psychiatric treatment.*
Yes
No
Been diagnosed with a mental health condition or a learning/developmental disorder that requires ongoing care.*
Yes
No
An addiction to drugs or alcohol requiring treatment within the last 5 years.*
Yes
No

__________________________________________________________________________

Box F - I have/have had:

__________________________________________________________________________

Recurrent back problems in the last 6 months that limit my everyday activity.*
Yes
No
Back or spinal surgery within the last 12 months.*
Yes
No
Diabetes, either insulin- or diet-controlled, OR gestational diabetes within the last 12 months.*
Yes
No
An uncorrected hernia that limits my physical abilities.*
Yes
No
Active or untreated ulcers, problem wounds, or ulcer surgery within the last 6 months.*
Yes
No

__________________________________________________________________________

Box G - I have had:

__________________________________________________________________________

Ostomy surgery and do not have medical clearance to swim or engage in physical activity.*
Yes
No
Dehydration requiring medical intervention within the last 7 days.*
Yes
No
Active or untreated stomach or intestinal ulcers or ulcer surgery within the last 6 months.*
Yes
No
Frequent heartburn, regurgitation, or gastroesophageal reflux disease (GERD).*
Yes
No
Active or uncontrolled ulcerative colitis or Crohn's disease.*
Yes
No
Bariatric surgery within the last 12 months.*
Yes
No

__________________________________________________________________________

* If you answered YES to questions 3, 5 or 10 above OR to any of the questions on Boxes A,B,C,D,E,F or G , please read and agree to the statement above by signing AND complete the Medical Form with your physician from our website or download the Medical Form below from the link provided. Take all three pages of the form (Participant Questionnaire and the Physician's Evaluation Form) to your physician for a medical evaluation.


Participation in a diving course requires your physician's approval.

To print a physical form for your physican please print this Medical Form 

__________________________________________________________________________




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.

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.


One or more problems exist. Please scroll up.




Powered by  Smartwaiver - TRY IT FREE!