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BOAT TRAVEL AND SCUBA DIVING VOLUNTARY RELEASE, WAIVER, AND ASSUMPTION OF RISK

Please read carefully, initial, and fill in all blanks before signing below.

I hereby affirm that I am a certified diver or a student under the control and supervision of a certified SCUBA instructor and that I thoroughly understand the potential risks of SCUBA diving including those hazards occurring during boat travel to and from the dive site. I understand that these hazards include, but are not limited to: decompression sickness, lung expansion injuries, drowning, slipping or falling while on board, being cut or struck by a boat while in the water, injuries occurring while getting on or off a boat and other injuries, death, or perils of the sea. I understand and am aware that SCUBA diving can be a dangerous and physically demanding activity. I certify that I am fully aware of and expressly assume these and all other risks involved in making such a dive or dives, whether conducted as a recreational dive, specialty 3 tank charter, night dive, or as part of a diving class. Diving with compressed air involves certain inherent risks; decompression sickness, embolism or other hyperbaric injury can occur that require treatment in a recompression chamber. Open water scuba diving trips may be conducted at a site that is remote, either by time or distance, from such a recompression chamber. At this time the closest hyperbaric treatment center in the State of Hawaii is at the University Health Partners - Hyperbaric Treatment Center at the Kuakini Medical Center in Honolulu. 

I understand and agree that neither the Captain, Crew members and Instructors of Seasport Divers, nor Seasport Divers or Kainani Corp., the vessel, owners, officers, employees, agents, or assigns of the above listed individuals and/or entities (herein-after "Released Parties") may be held liable or responsible in any way for any occurrence on this dive trip which may result in personal injury, property damage, wrongful death or other damage to me or my family, heirs, or assigns that may occur as a result of my participation in this boat trip and SCUBA dive(s) or as a result of the negligence of any party, including Released Parties, whether passive or active. 

I declare that I am in good mental and physical fitness for diving, and that I am not under the influence of alcohol, nor am I under the influence of any drugs that are contraindicated to diving. If I am taking medication, I declare that I have seen a physician and have approval to dive while under the influence of the medication/drugs.

Possible Changes- I understand that the scheduled charter destinations are subject to weather and conditions, and Seasport Divers or Kainani Corp. reserve the right to cancel charters or change destination at any time. I further understand that some charters or activities may be cancelled at any time due to lack of sufficient participation. 

Certified Diver Warranty of Skill Level- If I am a participating in a dive charter as a certified diver, I warrant that I have at least the same knowledge and skill level as that of a newly certified Open Water diver. I further understand that any underwater guide service provided by Kainani Inc. dba Seasport Divers is done so solely to enhance my enjoyment and not because such guidance is required to compensate for lack of ability on my part. 

Altitude Considerations: Helicopter Tours, Driving to Koke'e / Waimea Canyon Wait a minimum surface interval of 12 hours for a single dive: 18 hours for multiple dives before flying after diving. If you plan to make daily, multiple dives for several days or make a dive requiring an emergency decompression stop, take a special precaution — it's recommended that you extend the surface interval to a minimum 24 hours prior to flying after diving. There is currently no recommendation for driving to altitude after diving. Conservatism is prudent.

I, BY THIS INSTRUMENT, DO HEREBY EXEMPT AND RELEASE ALL THE ABOVE LISTED ENTITIES AND/OR INDIVIDUALS FROM ALL LIABILITY AND RESPONSIBILITY FOR PERSONAL INJURY, PROPERTY DAMAGE OR WRONGFUL DEATH HOWEVER CAUSED, INCLUDING, BUT NOT LIMITED TO, PRODUCT LIABILITY OR THE NEGLIGENCE OF THE RELEASED PARTIES. WHETHER PASSIVE OR ACTIVE.

I ACKNOWLEDGE THAT I HAVE READ THE FOREGOING PARAGRAPHS, FULLY UNDERSTAND THE POTENTIAL DANGERS INCIDENTAL TO ENGAGING IN THIS BOAT TRIP AND SCUBA DIVE(S), AM FULLY AWARE OF THE LEGAL CONSEQUENCES OF SIGNING THIS INSTRUMENT, AND THAT I UNDERSTAND AND AGREE THAT THIS DOCUMENT IS LEGALLY BINDING AND WILL PRECLUDE ME FROM RECOVERING MONETARY DAMAGES FROM THE ABOVE LISTED ENTITIES AND/OR INDIVIDUALS. WHETHER SPECIFICALLY NAMED OR NOT, FOR PERSONAL INJURY, PROPERTY DAMAGE OR WRONGFUL DEATH CAUSED BY NEGLIGENCE OR PRODUCT LIABILITY.

Photo and Video Release Form

I acknowledge that photos and/or videos taken by Seasport Divers, the Professional Staff of Seasport Divers, or any representative of Kainani Inc. DBA Seasport Divers, may include me. I hereby grant the right and permission to copyright and/or use and/or publish and republish, broadcast and rebroadcast, and/or distribute and redistribute photos and/or videos, in whole or in part, of me made on or about the date above, to the photographers, videographers, or their companies, as appropriate, for use in articles, advertising, Facebook photo-tagging, or for any other purposes in printed, electronic or any other media including, but not limited to, Facebook, magazines, books, newsletters, web sites, CD-ROMs, DVDs, tapes and other forms of still and/or motion media, including media that may not exist currently, but that is developed in the future. Such use may be worldwide. I further grant such individual or company the right to transfer and/or assign this right and permission, permanently or temporarily, to any person, agent, entity or company in connection with said purposes. I acknowledge that the photograph(s)/video(s) may be altered, enhanced or edited through photographic or computer methods.

I understand that no payment will be paid to me now or in the future. I agree that copyright ownership of any photos, video, or other media resulting from this agreement shall be owned by the individual or company, as appropriate, taking the picture, video, or other media.

I hereby warrant that I am of full age and competent to contract in my own name in so far as the contents of this release are concerned; or, if the person is under age 18, that I am the parent or legal guardian of said minor and I have the legal right to sign this agreement on the minor's behalf. I have read the above and I frilly understand its contents.

Dated: April 20, 2024

THANK YOU FOR COMING OUT WITH US.

WE HOPE YOU HAVE A WONDERFUL TIME AND WILL COME BACK SOON! 

ALOHA 






Please select who will be participating...
AdultMinor
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First Participant's Name

First Name*

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Signature*
Participant's 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 or Guardian's Email Address

Email*

Confirm Email*
Updates of new exciting discounted vacation packages. equipment sales, customer feedback, etc.
Emergency Contact

(Please list someone who will not be on the boat with you)


Emergency Contact's Name *

Emergency Contact's Phone Number *
Certification Information
Agency*

Certification Number: (if non-certified intro diver, write 'NA') *

Certification Level: (if non-certified intro diver, write 'NA') *

Date of your last dive: (if non-certified intro diver write, 'NA') *

Number of total dives: (if non-certified intro diver, write 'NA') *
Participant's Diver Information

Diver Medical Questionnaire

Recreational scuba diving and freediving requires good physical and mental health. There are a few medical conditions which can be hazardous while diving, listed below. Those who have, or are predisposed to, any of these conditions, should be evaluated by a physician. This Diver Medical Participant Questionnaire provides a basis to determine if you should seek out that evaluation. If you have any concerns about your diving fitness not represented on this form, consult with your physician before diving. If you are feeling ill, avoid diving. If you think you may have a contagious disease, protect yourself and others by not participating in dive training and/ or dive activities. References to “diving” on this form encompass both recreational scuba diving and freediving. This form is principally designed as an initial medical screen for new divers, but is also appropriate for divers taking continuing education. For your safety, and that of others who may dive with you, answer all questions honestly

Note to women: If you are pregnant, or attempting to become pregnant, do not dive.

1. I have had problems with my lungs, breathing, heart and/or blood affecting my normal physical or mental performance. *
No
Yes (Go to Box A)
2. I am over 45 years of age.*
No
Yes (Go to Box B)
3. I struggle to perform moderate exercise (for example, walk 1.6 kilometer/ one mile in 14 minutes or swim 200 meters/yards without resting), OR I have been unable to participate in a normal physical activity due to fitness or health reasons within the past 12 months. *
No
Yes
4. I have had problems with my eyes, ears, or nasal passages/sinuses*
No
Yes (Go to Box C)
5. I have had surgery within the last 12 months, OR I have ongoing problems related to past surgery.*
No
Yes
6. I have lost consciousness, had migraine headaches, seizures, stroke, significant head injury, or suffer from persistent neurologic injury or disease. *
No
Yes (Go to Box D)
7. I am currently undergoing treatment (or have required treatment within the last 5 years) for psychological problems, personality disorder, panic attacks, or an addiction to drugs or alcohol' or, I have been diagnosed with a learning or developmental disability. *
No
Yes (Go to Box E)
8. I have had back problems, hernia, ulcers, or diabetes. *
No
Yes (Go to Box F)
9. I have had stomach or intestine problems, including recent diarrhea*
No
Yes (Go to Box G)
10. I am taking prescription medications (with the exception of birth control or anti-malarial drugs other than mefloquine (Lariam).*
No
Yes

If you answered NO to all 10 questions above, no further questions nor a medical evaluation is required. Please skip down and read and agree to the participant statement below by signing and dating it. 


BOX A - I HAVE/HAVE HAD:


Chest surgery, heart surgery, heart valve surgery, an implantable medical device (eg, stent, pacemaker, neurostimulator), pneumothorax, and/or chronic lung disease. *
No
Yes
Asthma, wheezing, severe allergies, hay fever or congested airways within the last 12 months that limits my physical activity/exercise.*
No
Yes
A problem or illness involving my heart such as: angina, chest pain on exertion, heart failure, immersion pulmonary edema, heart attack or stroke, OR am taking medication for any heart condition.*
No
Yes
Recurrent bronchitis and currently coughing within the past 12 months, OR have been diagnosed with emphysema.*
No
Yes
Symptoms affecting my lungs, breathing, heart and/or blood in the last 30 days that impair my physical or mental performance. *
No
Yes

BOX B - I AM OVER 45 YEARS OF AGE AND:


I currently smoke or inhale nicotine by other means. *
No
Yes
I have a high cholesterol level.*
No
Yes
I have high blood pressure.*
No
Yes
I have had a close blood relative die suddenly or of cardiac disease or stroke before the afe of 50, OR have a family history of heart disease before age 50 (including abnormal heart rhythms, coronary artery disease or cardiomyopathy).*
No
Yes

BOX C - I HAVE/HAVE HAD:

Sinus surgery within the last 6 months*
No
Yes
Ear disease or ear surgery, hearing loss, or problems with balance.*
No
Yes
Recurrent sinusitis within the past 12 months*
No
Yes
Eye surgery within the past 3 months*
No
Yes

BOX D - I HAVE/HAVE HAD:

Head injury with loss of consciousness within the past 5 years. *
No
Yes
Persistent neurologic injury or disease. *
No
Yes
Recurring migraine headaches within the past 12 months, or take medications to prevent them.*
No
Yes
Blackouts or fainting (full/partial loss of consciousness) within the last 5 years. *
No
Yes
Epilepsy, seizures, or convulsions, OR take medications to prevent them. *
No
Yes

BOX E - I HAVE/HAVE HAD:


Behavioral health, mental, or psychological problems requiring medical/psychiatric treatment. *
No
Yes
Major depression, suicidal ideation, panic attacks, or uncontrolled bipolar disorder requiring medication/psychiatric treatment. *
No
Yes
Been diagnosed with a mental health condition or a learning/developmental disorder that requires ongoing care or special accommodation. *
No
Yes
An addiction to drugs or alcohol requiring treatment within the last 5 years. *
No
Yes

BOX F - I HAVE/HAVE HAD:


Recurrent back problems in the last 6 months that limit my everyday activity. *
No
Yes
Back or spinal surgery within the last 12 months*
No
Yes
Diabetes, either drug or diet controlled, OR gestational diabetes within the last 12 months*
No
Yes
An uncorrected hernia that limits my physical abilities. *
No
Yes
Active or untreated ulcers, problem wounds, or ulcer surgery within the last 6 months*
No
Yes

BOX G - I HAVE HAD:


Ostomy surgery and do not have medical clearance to swim or engage in physical activity. *
No
Yes
Dehydration requiring medical intervention within the last 7 days. *
No
Yes
Active or untreated stomach or intestinal ulcers or ulcer surgery within the last 6 months. *
No
Yes
Frequent heartburn, regurgitation, or gastroesophageal reflux disease (GERD).*
No
Yes
Active or uncontrolled ulcerative colitis or Crohn's disease. *
No
Yes
Bariatric surgery within the last 12 months. *
No
Yes

If you answered YES to questions 3, 5, or 10 above OR to any of the questions on page 2, please read and agree to the statement below by signing and dating it AND having a physician sign the medical evaluation form. (The full medical form was sent in your confirmation email and can be found at the link below). 

Participant Statement: I have answered all questions honestly, and understand that I accept responsibility for any consequences resulting from any questions I may have answered inaccurately or for my failure to disclose any existing or past health conditions. 




Diver Medical Questionnaire


https://seasportdivers.com/wp-content/uploads/2020/10/10346E_Diver-Medical_Form.pdf


  
If you answered YES to questions 3, 5, or 10 above OR to any of the questions on page 2, please upload your completed physician's medical clearance form here. Valid file types: JPG, GIF, PNG, and PDF
Valid file types: JPG, GIF, PNG, and PDF
Where did you first hear about us?
(Please check all that apply) *
Facebook
Trip Advisor
Kauai Adventure/Romance
101 Things To Do
Scuba Diving Magazine
Sportdiver Magazine
Best of Kauai
Yelp
Northwest Dive News
Mainland Dive Shop
Local / Friend
Repeat Customer
Other

If Other, please describe:
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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