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POOL USE LIABILITY RELEASE & HOLD HARMLESS AGREEMENT

In consideration of permitting me, (name provided below) to participate in swimming/snorkeling/Freediving/scuba diving activities and related operations conducted by employees, instructors or agents, of Chesapeake Bay Dive and Aquatic Center Inc. in the pool located at 1725 Laskin Road Suite 515 Virginia Beach VA. 23454 on the day of TBD 2025 for myself, my personal representatives, heirs and next of kin:

HEREBY acknowledge that SWIMMING/SNORKELING/FREEDIVING/SCUBA DIVING IS A POTENTIALLY DANGEROUS ACTIVITY and involves the risk of serious injury and/or death and/or property damage. I FURTHER ACKNOWLEDGE that diving with compressed air involves certain risks and injuries that can occur which require treatment in a recompression chamber or other facility.

I HEREBY RELEASE, WAIVE, DISCHARGE AND AGREE NOT TO SUE the above dive business, its facility, the dive leader, or any of its officers, instructors, agents or employees (the Releases) FROM ALL LIABILITY TO MYSELF, my personal representatives, assigned heirs, and next of kin FOR ANY AND ALL LOSS OR DAMAGE, AND ANY CLAIM OR DEMANDS THEREFOR ON ACCOUNT OF INJURY TO MY PERSON OR PROPERTY OR RESULTING IN MY DEATH, NOW AND FOREVER, ARISING OUT OF OR RELATED TO PARTICIPATION IN SAID RELATED DIVING OPERATIONS THAT MAY OCCUR, WHETHER CAUSED BY THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE.

I HEREBY ASSUME FULL RESPONSIBILITY FOR ANY RISK OF BODILY INJURY, DEATH OR PROPERTY DAMAGE, now and forever, arising out of or related to participation of said activities or any other related diving operations, whether foreseen or unforeseen and whether caused by the negligence of the Releases or otherwise, I HEREBY SEPARATELY agree to INDEMNIFY and SAVE and HOLD HARMLESS the releases from any loss, liability, damage or cost that they may incur, now and forever, arising out of or related to participation in diving operations, whether caused by the negligence of the Releases or otherwise.

HEREBY acknowledge that INJURIES RECEIVED MAY BE COMPOUNDED OR INCREASED BY NEGLIGENT RESCUE OPERATIONS OR PROCEDURES OF THE RELEASEES AND AGREE THAT THIS Waiver and Release of Liability, Assumption or Rick and Indemnity Agreement extends to all acts of negligence by Releases, INCLUDINGNEGLIGENT RESCUE OPERATIONS and is intended to be as broad and inclusive as permitted by the laws of the Province or State in which the activities are conducted and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect.

I have read this Waiver and Release of Liability, Assumption or Risk and Indemnity Agreement, fully understand its terms, understand that I have given up substantial rights by signing it, am aware of its legal consequences, and have signed it freely and voluntarily without any inducement, assurance, or guarantee being made to me and intend my signature to be a complete and unconditional release of all liability to the greatest extent allowed by law. I have had the opportunity to personally discuss with the dive leader the potential dangers incidental to engaging in the activity of snorkeling or scuba diving and related diving operations.

DATE: January 29, 2026

First Participant's Name
First Name*
Last Name*
First Participant's Date of Birth*
Date of Birth
Information
Scuba Certification*
Yes, I am Scuba Certified.
No
Scuba Agency*
Agency Cert #
First Participant's Signature*
Second Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Information
Scuba Certification*
Yes, I am Scuba Certified.
No
Scuba Agency*
Agency Cert #
Third Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Information
Scuba Certification*
Yes, I am Scuba Certified.
No
Scuba Agency*
Agency Cert #
Fourth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Information
Scuba Certification*
Yes, I am Scuba Certified.
No
Scuba Agency*
Agency Cert #
Fifth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Information
Scuba Certification*
Yes, I am Scuba Certified.
No
Scuba Agency*
Agency Cert #
Sixth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Information
Scuba Certification*
Yes, I am Scuba Certified.
No
Scuba Agency*
Agency Cert #
Seventh Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Information
Scuba Certification*
Yes, I am Scuba Certified.
No
Scuba Agency*
Agency Cert #
Eighth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Information
Scuba Certification*
Yes, I am Scuba Certified.
No
Scuba Agency*
Agency Cert #
Ninth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Information
Scuba Certification*
Yes, I am Scuba Certified.
No
Scuba Agency*
Agency Cert #
Tenth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Information
Scuba Certification*
Yes, I am Scuba Certified.
No
Scuba Agency*
Agency Cert #
Parent or Guardian's Email Address
Email
Activity Date
Date of Activity:
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*
Last Name*
Phone*
Parent or Guardian's Date of Birth*
Date of Birth
Information
Scuba Certification*
Yes, I am Scuba Certified.
No
Scuba Agency*
Agency Cert #
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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