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DIVE PROFESSIONAL- INSTRUCTOR SCUBA DIVING ASSUMPTION OF RISK AGREEMENT & LIABILITY RELEASE

Assumption of Risk Agreement and Liability Release

I understand that scuba diving with compressed air involves certain inherent risks, including but not limited to decompression sickness, embolism, or other hyperbaric/air expansion injuries, that require treatment in a recompression chamber, and that treatment at such a facility is some distance and time from the dive site. I still choose to participate in such activities in spite of the possible absence of a recompression chamber in proximity to the Pearl Lake Beach, LLC dive site. I hereby personally assume all risks in connection with any scuba diving activity, for any harm, injury, or damage that may befall me while I am a participant in scuba diving, including all risks connected therewith, whether foreseen or unforeseen. I realize that some diving activities may involve advanced knowledge, skills, and experience. I agree to not participate in any activities that are beyond the scope of my training and/or certification level. I also realize that diving in an overhead environment involves specialized training and equipment and that some sites in the lake may represent such a circumstance. I further am aware and

understand that diving near any object or associated reference lines present in the lake can present the possibility of entan glement and that I should use appropriate caution in that regard.

I agree that at any time, should I feel uncomfortable with any or all activities, I will refrain from participating in that particular activity. I confirm that all my diving equipment has been properly maintained and is in good working order and condition to the best of my knowledge. I will inspect all of my equipment prior to scuba diving activity. I will not hold the Pearl Lake Beach LLC (here after referred to as "Released Parties") responsible for use of inadequately maintained equipment or my failure to inspect my equipment prior to scuba diving. Relative to any diving activities that I participate in, I declare that I am a diver in training under the supervision of a certified diving educator OR a certified scuba diver who is certified through a recognized agency, trained in safe diving practices, and am aware that scuba diving has inherent risks which may result in serious injury or death, and that I am in good mental and physical fitness to participate in scuba diving activities. I understand and agree that neither Pearl Lake Beach LLC, nor the dive professional(s) or divers affiliated with Pearl Lake Beach LLC or present at the dive site/activity, nor their respective employees, officers, agents, assigns or associated individuals (here after referred to as "Released Parties"), may be held liable or responsible in any way for any injury, death or damages to or loss of any property/equipment.

I further agree that neither myself nor my family, estate, heirs, or assigns will hold the "Released Parties" responsible for any occurrence that may result in injury, death or loss that may occur as a result of my participation in this activity, or as a result of the negligence whether passive or active of any party, including the “Released Parties.”

I acknowledge and willingly assume all risks and hazards for all Pearl Lake Beach, LLC activities. I further understand that by this agreement that neither I, nor my family, estate, heirs, or assigns cannot make a claim, sue, or expect the owner’s officers, agents, employees, and associates, or its beneficiaries to be legally responsible or pay for any damage or injuries. The undersigned, understand and acknowledge that the above list is not complete or exhaustive and that other risks, known or unknown, anticipated or unanticipated, may also exist and may result in injury, illness, disease, death, or damage. My participation in any and all scuba diving activity is purely voluntary, and I elect to do so at my own risk at all times while at Pearl Lake Beach, LLC.

I am signing this Agreement of my own free will and with the knowledge and understanding that I hereby agree to waive all my legal rights. I further agree that 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 u nderstand 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 or injury.

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, , WITH THIS INSTRUMENT I DO HEREBY EXEMPT AND RELEASE PEARL LAKE BEACH, LLC AND ALL RELATED ENTITIES AS DEFINED ABOVE, FROM ALL LIABILITY OR RESPONSIBILITY WHATSOEVER FOR PERSONAL INJURY, PROPERTY DAMAGE OR WRONGFUL DEATH, HOWEVER CAUSED, INCLUDING BUT NOT LIMITED TO THE NEGLIGENCE OF THE RELEASED PARTIES, WHETHER PASSIVE OR ACTIVE.

I HAVE FULLY INFORMED MYSELF 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. I UNDERSTAND THAT BY ENTERING MY NAME ON THE ELECTRONIC SIGNATURE LINE, I AM GIVING UP LEGAL RIGHTS FOR MYSELF AND ALL OTHERS WHO MAY HAVE A CLAIM ON MY OR THEIR BEHALF AGAINST THE RELEASED PARTIES AS A RESULT OF MY PARTICIPATION IN THE ACTIVITIES. 

April 15, 2025

First Dive Professional/ Instructor Name

First Name*

Middle Name

Last Name*

Phone*
First Dive Professional/ Instructor Date of Birth*
First Dive Professional/ Instructor Signature*
Second Dive Professional/ Instructor Name

First Name*

Middle Name

Last Name*
Second Dive Professional/ Instructor Date of Birth*
Third Dive Professional/ Instructor Name

First Name*

Middle Name

Last Name*
Third Dive Professional/ Instructor Date of Birth*
Fourth Dive Professional/ Instructor Name

First Name*

Middle Name

Last Name*
Fourth Dive Professional/ Instructor Date of Birth*
Fifth Dive Professional/ Instructor Name

First Name*

Middle Name

Last Name*
Fifth Dive Professional/ Instructor Date of Birth*
Sixth Dive Professional/ Instructor Name

First Name*

Middle Name

Last Name*
Sixth Dive Professional/ Instructor Date of Birth*
Seventh Dive Professional/ Instructor Name

First Name*

Middle Name

Last Name*
Seventh Dive Professional/ Instructor Date of Birth*
Eighth Dive Professional/ Instructor Name

First Name*

Middle Name

Last Name*
Eighth Dive Professional/ Instructor Date of Birth*
Ninth Dive Professional/ Instructor Name

First Name*

Middle Name

Last Name*
Ninth Dive Professional/ Instructor Date of Birth*
Tenth Dive Professional/ Instructor Name

First Name*

Middle Name

Last Name*
Tenth Dive Professional/ Instructor Date of Birth*
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
Dive Professional/ Instructor 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:*
Professional Diving Liability Insurance Info:

Diving Liability Insurance Carrier:

Current Term : *

Policy Number: *
OR Group Diving Liability Insurance Carrier:

Group Diving Liability Insurance Carrier

Insured Store/Organization:

Policy Number:
REQUIRED: Certificate Of Insurance with PEARL LAKE BEACH, LLC Listed as an ADDITIONAL INSURED
  
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Dive Store Affiliation

Dive store name/ phone
Certification Agency Affiliation

Agency / Level

Agency/ Level
Diving Professional Statement of Understanding/Agreement:

I, am currently certified by a nationally-recognized agency, in good standing, physically-capable

and trained to act as a dive leadership professional in the training and/or supervision of diving students or certified divers by the

certification agency/agencies listed above and will do so within that agency’s standards and procedures and within the limitations

of that agency relative my professional certification-level as listed above. I will also conduct any and all training or supervision of

students or certified divers within industry-published Standard Safe Diving Practices. I further certify that all of the information

listed previously is accurate and correct.

Current certificates are required to be submitted at the beginning of each PLB diving season and to be re-submitted on the policy’s

annual renewal date if during that current PLB diving season.

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*
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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