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NAUI TECHNICAL DIVING RELEASE OF LIABILITY, WAIVER OF CLAIMS, AND EXPRESS ASSUMPTION OF RISK AGREEMENT

PLEASE READ AND BE CERTAIN YOU UNDERSTAND THE IMPLICATIONS OF SIGNING THIS RELEASE. 

I

 hereby affirm and acknowledge that I have been fully informed of the unique and inherent hazards and risks of Technical SCUBA Diving activities. I fully understand that Technical Open-Circuit, Semi-Closed, and Closed-circuit SCUBA Diving with compressed air, oxygen or multiple mixed gases involves certain inherent hazards and risks including, but not limited to decompression sickness, embolism, oxygen toxicity, hypoxia, narcosis, barotrauma, hyperbaric injuries, equipment failure and user error that can lead to serious permanent injury and loss of life. I understand that diving activities may be conducted at a site that is remote from a recompression chamber and/or 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 Technical Diving 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 re-boarding the vessel to begin or end diving activities, as well as during travel to and from dive sites. Despite the potential hazards and risks associated with Technical Diving and related activities 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, navigational lines, 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 Technical Diving and related activities 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 this Technical SCUBA Diving course of instruction or activity, as well as the use of any of the facilities and the use of the equipment of the below listed persons and 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 (hereafter referred to as "Releasees"); National Association of Underwater Instructors, Inc. (NAUI) and subsidiary companies ; Atlantic Divers LLC, Peter Barto, Gene Peterson, Thomas Stocker, Jennifer Patterson
  2. To release the Releasees, their officers, directors, employees, representatives, agents and volunteers, from any 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 Technical SCUBA Diving activities, whether caused by active or passive negligence of the Releasees or otherwise. By executing this Agreement, I agree to save and hold the Releasees harmless from any claim or lawsuit by me, my family, estate, heirs or assigns arising out of my participation in this Technical SCUBA Diving course, including both claims arising during the course, after I have received my certification, and any and all future courses of instruction, programs and dive related travel I undertake. 
  3. I fully understand that Technical SCUBA Diving activities 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, aquatic 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 representations 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 this 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 also declare that I am of legal age and competent to sign this Agreement.

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

Signature of Participant  

 September 16, 2024

Signature of Witness 

September 16, 2024

First Participant's Name

First Name*

Middle Name

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Signature*
Second Participant's Name

First Name*

Middle Name

Last Name*
Second Participant's Date of Birth*
Second Participant's Signature*
Third Participant's Name

First Name*

Middle Name

Last Name*
Third Participant's Date of Birth*
Third Participant's Signature*
Fourth Participant's Name

First Name*

Middle Name

Last Name*
Fourth Participant's Date of Birth*
Fourth Participant's Signature*
Fifth Participant's Name

First Name*

Middle Name

Last Name*
Fifth Participant's Date of Birth*
Fifth Participant's Signature*
Sixth Participant's Name

First Name*

Middle Name

Last Name*
Sixth Participant's Date of Birth*
Sixth Participant's Signature*
Seventh Participant's Name

First Name*

Middle Name

Last Name*
Seventh Participant's Date of Birth*
Seventh Participant's Signature*
Eighth Participant's Name

First Name*

Middle Name

Last Name*
Eighth Participant's Date of Birth*
Eighth Participant's Signature*
Ninth Participant's Name

First Name*

Middle Name

Last Name*
Ninth Participant's Date of Birth*
Ninth Participant's Signature*
Tenth Participant's Name

First Name*

Middle Name

Last Name*
Tenth Participant's Date of Birth*
Tenth Participant's Signature*
Parent or Guardian's Email Address

Email*

Confirm Email*
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I hereby declare that I am a qualified SCUBA Diver and have been truthful in stating my qualifications as a certified SCUBA Diver from the following training agency/s :

and that I am aware of the required prerequisite certification/s or equivalent experience. I have been a certified diver since

and I have conducted a total of 

dives to a maximum depth of 


Feet of Seawater
Emergency Contact

First Name*

Last Name*

Emergency Contact's Phone Number*

Emergency Contact's Relation to Participant
Insurance

Insurance Carrier*

Insurance Policy Number*
Parent or Guardian's Driver's License / ID Card

Driver's License / ID Card Number*

Issuing State*
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*

Phone*
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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