Loading...

COMPLETE LIABILITY RELEASE AND ASSUMPTION OF RISK


1.   I UNDERSTAND THE PURPOSE OF SIGNING THIS DOCUMENT IS TO EXEMPT AND RELEASE Tarpoon Lagoon, HEREAFTER CALLED “THE DIVE STORE”, AND Deco Divers, HEREAFTER CALLED “VESSEL”, ITS EMPLOYEES, AGENT, AND DIVE BOATS WHETHER OWNED, OPERATED, LEASED OR CHARTERED AND TO HOLD THESE ENTITIES HARMLESS FROM ANY AND ALL LIABILITY ARISING AS A CONSEQUENCE OF THE FOLLOWING, OR ANY ACT OR OMISSIONS ON THEIR PART, INCLUDING, BUT NOT LIMITED TO, ACTIVE OR PASSIVE NEGLIGENCE.

2.   I am by my signature affirming that I am a certified scuba diver or a student diver. I have been taught and understand scuba diving is a hazardous activity with inherent risks and dangers associated therewith including, but not limited to, risks associated with equipment failure, perils of the sea and acts of fellow divers which could result in a serious injury or death. BY WAY OF MY SIGNATURE I EXPRESSLY ASSUME THESE RISKS. I assert that I am physically fit to participate in the sport of scuba diving and snorkeling and I agree by way of my signature that I will not hold any of the above named individuals, persons or entities responsible if I am injured as a result of any medical conditions while scuba diving and/or snorkeling. I do not have in my possession any illegal drugs, nor am I taking, nor have I recently taken any drugs or medication, which could cause an adverse reaction as a result of combining such drugs and/or medication with scuba diving.

3.   Prior to leaving the dock I will inspect all of my equipment to be used and I will notify the dive store of any equipment that I find to not be functioning properly. I will not hold the dive store or any of its employees, agents or dive boats, nor the vessel responsible for my failure to inspect my equipment prior to diving.

4.   I will be present and attentive to the safety briefings given by the Divemaster and the boat captains. I understand that I have an affirmative duty to plan and carry out my own dive and to be responsible for my own safety. By way of my signature I expressly agree that I will plan my dives as no decompression dives with at least a three-minute safety stop at 15 feet (5 metres) prior to ascending to the surface. I fully agree that I will start my ascent at the end of each dive with enough air to guarantee being on the vessel with a minimum amount of air in my tank as required by the dive leader.

5.   I will immediately cease and abort my dive if: (1) I feel uncomfortable with my diving abilities; and/or (2) Diving conditions are worse than those for which I have been trained or for which I am comfortable.

6.   I am fully aware and have been trained in the dangers, risks and hazards of holding my breath while diving on compressed air. I fully agree not to hold the above named individuals, entities or vessels responsible for any such act by me. In the eventuality that I become distressed at the surface, I will IMMEDIATELY drop my weight belt and INFLATE MY BUOYANCY COMPENSATOR. I understand that if l want or need any assistance from the Vessel, the Divemaster or the Captain I will give the proper "Diver in trouble" signal. I understand that this activity may be conducted in a remote site by time and distance from a medical facility and a recompression chamber. Nevertheless I expressly wish to proceed with this trip.

7.   BY WAY OF MY SIGNATURE ON THIS DOCUMENT IT IS MY EXPRESS INTENTION BY WAY OF THIS INSTRUMENT TO GIVE UP MY RIGHT TO SUE ALL INDIVIDUALS, OR ENTITIES OR VESSELS REFERRED TO HEREIN, WHETHER SPECIFICALLY NAMES OR NOT AND IT IS ALSO MY INTENTION TO EXEMPT AND RELIEVE THE VESSEL, ITS EMPLOYEES, AGENTS AND DIVE BOATS, WHETHER OWNED, OPERATED, LEASED OR CHARTERED FROM ALL LIABILITY ARISING AS A CONSEQUENCE OF ANY ACT OR OMISSION INCLUDING, BUT NOT LIMITED TO, ACTIVE OR PASSIVE NEGLIGENCE. BY WAY OF MY SIGNATURE ON THIS DOCUMENT I FULLY AGREE TO INDEMNIFY AND HOLD THESE ENTITIES NAMED WITHIN THIS DOCUMENT HARMLESS FROM ANY AND ALL LIABILITY FOR PERSONAL INJURY OF ANY SORT, PROPERTY DAMAGE OR WRONGFUL DEATH BY MYSELF, HEIRS AND ASSIGNEES, AND I ASSUME EXPRESSLY ALL RISKS IN CONNECTION WITH THE ACTIVITIES OF SNORKELING AND SCUBA DIVING.

8.   BY WAY OF MY SIGNATURE GIVEN VOLUNTARILY I EVIDENCE THAT I HAVE READ AND FULLY UNDERSTAND THE DOCUMENT IN ITS ENTIRETY. IF I HAVE ANY QUESTIONS WITH RESPECT TO THE CONTENTS OF THIS DOCUMENT I CERTIFY THAT I HAVE FULLY INFORMED MYSELF BEFORE SIGNING MY NAME BELOW. I FULLY AGREE TO THE TERMS AND CONDITIONS HEREIN AND REALIZE THEY ARE GIVEN IN EXCHANGE FOR THE DIVE STORE AND THE VESSEL ALLOWING ME TO PARTICIPATE IN THIS ACTIVITY. I UNDERSTAND THAT THIS IS A CONTRACT.


9. FLORIDA ADDENDUM NOTICE TO THE MINOR CHILDS PARENT OR 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 TARPOON LAGOON DIVE, DECO DIVERS, AND/OR PADI AMERICA, INC., OR ANY OF THEIR AFFILIATE AND SUBSIDIARY CORPORATIONS RESPECTIVE EMPLOYEES, OFFICERS, AGENTS, CONTRACTORS, INDEPENDENT CONTRACTOS, DIVE PROFESSIONSLAS, INSTRUCTORS AND ASSIGNS, USE REASONABLE CARE IN PROVIDING THIS ACTIVIETY, THERE IS A CHANGE THAT YOUR CHILD MAY BE SERIOUSLY INJURE OR KILLED BY PARTICIPATING IN THIS ACTIVITY BECAUSE THERE ARE CERTAIN DANGERS INHERENT IN THE AVTIVITY WHICH CANNOT BE AVOIDED OR ELIMINATED. BY SIGNING THIS FORM YOU ARE GIVING UP YOUR CHILD'S RIGHT AND YOUR RIGHT TO REVOER FROM TARPOON LAGOON DIVE CENTER, DECO DIVERS, AND/OR PADI AMERICAS, INC., OR ANY OF THEIR AFFILIATE AND SUBSIDIARY CORPORATIONS, RESPECITVE EMPLOYEES, OFFICERS, AGENTS, CONTRACTORS, INDEPENDENT CONTRACTORS, DIVE PROFESSIONALS, INSTRUCTORS AND ASSIGNS 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 FROM AND TARPOON LAGOON AND DECO DIVERS AND/OR PADI AMERICAS, INC., OR ANY OF THEIR AFFILIATE AND SUBSIDIARY CORPORATIONS, RESPECITVE EMPLOYEES, OFFICERS, AGENTS, CONTRACTORS, INDEPENDENT CONTRACTORS, DIVE PROFESSIONALS, INSTRUCTORS AND ASSIGNS HAVE THE RIGHT TO REFUSE TO LET YOUR CHILD PARTICIPATE IF YOU DO NOT SIGN THIS FORM.

I Agree


Today's Date: September 28, 2022



First Participant's Name

First Name*

Middle Name

Last Name*

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

Please select the date of your dive/snorkel trip:



Date of Dive/Snorkel Activity *

* No Certificate Number/Agency required for Student and Discover Scuba Diver


Certification Level:*

Diver Certificate Number:

Diver Certification Agency:

Date of Your Last Dive:
Dive Accident Insurance*
No
Yes

Insurance Co

Policy Number
First Participant's Signature*
Second Participant's Name

First Name*

Middle Name

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

Please select the date of your dive/snorkel trip:



Date of Dive/Snorkel Activity *

* No Certificate Number/Agency required for Student and Discover Scuba Diver


Certification Level:*

Diver Certificate Number:

Diver Certification Agency:

Date of Your Last Dive:
Dive Accident Insurance*
No
Yes

Insurance Co

Policy Number
Third Participant's Name

First Name*

Middle Name

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

Please select the date of your dive/snorkel trip:



Date of Dive/Snorkel Activity *

* No Certificate Number/Agency required for Student and Discover Scuba Diver


Certification Level:*

Diver Certificate Number:

Diver Certification Agency:

Date of Your Last Dive:
Dive Accident Insurance*
No
Yes

Insurance Co

Policy Number
Fourth Participant's Name

First Name*

Middle Name

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

Please select the date of your dive/snorkel trip:



Date of Dive/Snorkel Activity *

* No Certificate Number/Agency required for Student and Discover Scuba Diver


Certification Level:*

Diver Certificate Number:

Diver Certification Agency:

Date of Your Last Dive:
Dive Accident Insurance*
No
Yes

Insurance Co

Policy Number
Fifth Participant's Name

First Name*

Middle Name

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

Please select the date of your dive/snorkel trip:



Date of Dive/Snorkel Activity *

* No Certificate Number/Agency required for Student and Discover Scuba Diver


Certification Level:*

Diver Certificate Number:

Diver Certification Agency:

Date of Your Last Dive:
Dive Accident Insurance*
No
Yes

Insurance Co

Policy Number
Sixth Participant's Name

First Name*

Middle Name

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

Please select the date of your dive/snorkel trip:



Date of Dive/Snorkel Activity *

* No Certificate Number/Agency required for Student and Discover Scuba Diver


Certification Level:*

Diver Certificate Number:

Diver Certification Agency:

Date of Your Last Dive:
Dive Accident Insurance*
No
Yes

Insurance Co

Policy Number
Seventh Participant's Name

First Name*

Middle Name

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

Please select the date of your dive/snorkel trip:



Date of Dive/Snorkel Activity *

* No Certificate Number/Agency required for Student and Discover Scuba Diver


Certification Level:*

Diver Certificate Number:

Diver Certification Agency:

Date of Your Last Dive:
Dive Accident Insurance*
No
Yes

Insurance Co

Policy Number
Eighth Participant's Name

First Name*

Middle Name

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

Please select the date of your dive/snorkel trip:



Date of Dive/Snorkel Activity *

* No Certificate Number/Agency required for Student and Discover Scuba Diver


Certification Level:*

Diver Certificate Number:

Diver Certification Agency:

Date of Your Last Dive:
Dive Accident Insurance*
No
Yes

Insurance Co

Policy Number
Ninth Participant's Name

First Name*

Middle Name

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

Please select the date of your dive/snorkel trip:



Date of Dive/Snorkel Activity *

* No Certificate Number/Agency required for Student and Discover Scuba Diver


Certification Level:*

Diver Certificate Number:

Diver Certification Agency:

Date of Your Last Dive:
Dive Accident Insurance*
No
Yes

Insurance Co

Policy Number
Tenth Participant's Name

First Name*

Middle Name

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

Please select the date of your dive/snorkel trip:



Date of Dive/Snorkel Activity *

* No Certificate Number/Agency required for Student and Discover Scuba Diver


Certification Level:*

Diver Certificate Number:

Diver Certification Agency:

Date of Your Last Dive:
Dive Accident Insurance*
No
Yes

Insurance Co

Policy Number
Parent or Guardian's Email Address

Email*

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

Emergency Contact's Name*

Emergency Contact's Phone Number*
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*

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

Please select the date of your dive/snorkel trip:



Date of Dive/Snorkel Activity *

* No Certificate Number/Agency required for Student and Discover Scuba Diver


Certification Level:*

Diver Certificate Number:

Diver Certification Agency:

Date of Your Last Dive:
Dive Accident Insurance*
No
Yes

Insurance Co

Policy 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.


One or more problems exist. Please scroll up.




Powered by  Smartwaiver - TRY IT FREE!