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7834 SW Jack James Drive, Stuart, FL 34997

772-419-7199

admin@d-dey.com

D-Dey.com


Waiver of Liability and Acknowledgement

Prescription Medical Kits from D-DEY Response Group

I hereby release D-DEY Response Group and its respective directors, officers, shareholders, employees, agents, contractors and their successors and assigns (collectively, the “Releasees”) from and against any and all liability for any loss, damage, injury, expense, demand or cause of action that I may suffer or cause to others with respect to personal injury, death, damage to or destruction of property, theft or otherwise, which may arise as a result of my decisions to use the training, equipment, or Prescription Medical Kits from D-DEY Response Group.

Acknowledgement: The Prescription Medical Kit is dispensed to those embarking on an extended Ocean Voyage.

• I am aware and acknowledge that injury or death may result from Ocean Voyages and from the use any equipment therein or thereon provided by D-DEY Response Group.


• It is designed and intended for use at seaand where direct access to professional medical care is not an option. All medications, medical items and supplies are to be used under the direct supervision of the Captain / Skipper and / or the designated Medical Officer onboard. Whenever possible a physician should be consulted prior to the use of any prescription medication. Additional training may be required for the proper use of medical equipment and supplies.All prescription medications must be administered in accordance with the product literature and all printed instructions. Use of any medication must be terminated at the onset of any side effect or adverse reaction. 


• Prescription Medical Kits contain medications provided in anticipation of first aid or emergency medical situations that might arise and are not intended to replace any medications that might be prescribed by one's own personal physician. An individual should be fully informed by one's own personal physician with regard to any and all complications and contra-indications that might arise as the result of the use of those medications and in conjunction with the use of any other medication. 


• The Vessel, Managing Owner, and Captain/Crew have received training on ONLY the medications provided in D-DEY Response Group’s Prescription Medicine Kit. D-DEY Response Group cannot be held liable for the misuse, abuse, or complications for medicines it does not provide. 


• I will indemnify and hold harmless D-DEY Response Group, collectively and individually, from any and all losses, liabilities, damages, demands, costs and expenses that they may incur, for any reason whatsoever, which may arise as a result of my participation in the contemplated activity. 


• I acknowledge that I have read this Waiver of Liability, and have received the opportunity to discuss this with my legal counsel. Further, I acknowledge that I fully understand the terms of this Waiver of Liability and that I have signed it freely and voluntarily without any inducement, assurance, guarantee or oral representation being made. 


February 4, 2025

First Purchaser Name

First Name*

Last Name*

Phone*
First Purchaser Date of Birth*
First Purchaser Signature*
Second Purchaser Name

First Name*

Last Name*
Second Purchaser Date of Birth*
Third Purchaser Name

First Name*

Last Name*
Third Purchaser Date of Birth*
Fourth Purchaser Name

First Name*

Last Name*
Fourth Purchaser Date of Birth*
Fifth Purchaser Name

First Name*

Last Name*
Fifth Purchaser Date of Birth*
Sixth Purchaser Name

First Name*

Last Name*
Sixth Purchaser Date of Birth*
Seventh Purchaser Name

First Name*

Last Name*
Seventh Purchaser Date of Birth*
Eighth Purchaser Name

First Name*

Last Name*
Eighth Purchaser Date of Birth*
Ninth Purchaser Name

First Name*

Last Name*
Ninth Purchaser Date of Birth*
Tenth Purchaser Name

First Name*

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

Email*

Confirm Email*
Documentation for the RX Kit is in the name of:

Vessel Name *

Vessel Registration Number *

Managing Captain/ Owner (noted on the vessel document or registration) *

Captain or Medical Officer *
Purchaser 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*

Last Name*

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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