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Please read carefully before signing.

THIS AGREEMENT is entered into between Southeast Scuba Escape, LLC (Dive Center/Resort) and (Rentor) for the rental of scuba and/or skin diving equipment. This AGREEMENT is a release of my rights and the rights of my heirs, assigns or beneficiaries to sue for injuries or death resulting from the rental and/or use of this equipment. I personally assume all risks of skin and/or scuba diving, whether foreseen or unforeseen, related in any way to the rental and/or use of this equipment.

Non-Agency Disclosure and Acknowledgment Agreement

I understand and agree that PADI Members (“Members”), including Southeast Scuba Escape, LLC and/or any individual PADI Instructors and Divemasters associated with the program in which I am participating, are licensed to use various PADI Trademarks and to conduct PADI training, but are not agents, employees or franchisees of PADI Americas, Inc, or its parent, subsidiary and affiliated corporations (“PADI”). I further understand that Member business activities are independent, and are neither owned nor operated by PADI, and that while PADI establishes the standards for PADI diver training programs, it is not responsible for, nor does it have the right to control, the operation of the Members’ business activities and the day-to-day conduct of PADI programs and supervision of divers by the Members or their associated staff. I further understand and agree on behalf of myself, my heirs and my estate that in the event of an injury or death during this activity, neither I nor my estate shall seek to hold PADI liable for the actions, inactions or negligence of Southeast Scuba Escape, LLC and/ or the instructors and divemasters associated with the activity.


Liability Release and Assumption of Risk Agreement

I understand and agree that Southeast Scuba Escape, LLC, and its employees, owners, officers, contractor, assigns or agents (hereinafter referred to as “Released Parties”), shall not be held liable or responsible in any way for any injury, death or other damages to me, my family, estate, heirs or assigns which may occur as a result of the rental and/or use of the equipment, or as a result of product defect, or the negligence of any party, including the Released Parties, whether passive or active. I hereby acknowledge receipt of the equipment designated in this form, and, if any of this equipment is to be used for scuba diving I affirm I am a certified scuba diver or student diver in a scuba diving course/program under the supervision of a certified scuba instructor. I affirm it is my responsibility to inspect all of the equipment and acknowledge it is in good working condition. I affirm that it is my responsibility to check both the quality and quantity of gas in any scuba tanks. I acknowledge that I should not dive if the equipment is not functioning properly. I will not hold the Released Parties responsible for my failure to inspect the equipment prior to diving or if I choose to dive with equipment that may not be functioning properly. I understand that skin diving and scuba diving are physically strenuous activities, that I will be exerting myself during these activities, and that if I am injured as a result of heart attack, panic, hyperventilation, drowning or any other cause, that I expressly assume the risk of said injuries and that I will not hold the Released Parties responsible for the same.

 I agree to reimburse the Dive Center/Resort for the loss or breakage of any and all equipment at the current replacement value and to also pay for damages incurred while transporting the equipment. I agree to return the equipment in clean condition and to pay a cleaning fee if not returned cleaned. I further state that I am of lawful age and legally competent to sign this liability release, or that I have acquired the written consent of my parent or guardian. I understand the terms herein are contractual and not a mere recital, and that I have signed this Agreement of my own free act and with the knowledge that I hereby agree to waive my legal rights. I further agree 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 understand and agree that I am not only giving up my right to sue the Released Parties but also any rights my heirs, assigns, and beneficiaries may have to sue the Released Parties resulting from my death. I further represent I have the authority to do so and that my heirs, assigns, or beneficiaries will be estopped from claiming otherwise because of my representations to the Released Parties.

BY THIS INSTRUMENT I AGREE TO EXEMPT AND RELEASE THE RELEASED PARTIES AND ALL RELATED ENTITIES AS DEFINED ABOVE, FROM ALL LIABILITY OR RESPONSIBILITY WHATSOEVER FOR PERSONAL INJURY, PROPERTY DAMAGE, OR WRONGFUL DEATH AS A RESULT OF RENTING AND/OR USING THE EQUIPMENT, HOWEVER CAUSED, INCLUDING, BUT NOT LIMITED TO PRODUCT LIABILITY OR THE NEGLIGENCE OF THE RELEASED PARTIES, WHETHER PASSIVE OR ACTIVE. I HAVE FULLY INFORMED MYSELF AND MY HEIRS OF THE CONTENTS OF THIS NON-AGENCY DISCLOSURE AND ACKNOWLDGEMENT AGREEMENT AND LIABILITY RELEASE AND ASSUMPTION OF RISK AGREEMENT BY READING BOTH BEFORE SIGNING BELOW ON BEHALF OF MYSELF AND MY HEIRS.


First Rentor/Participant's Name

First Name*

Last Name*

Phone*
First Rentor/Participant's Date of Birth*
First Rentor/Participant's Information

Street Address *

City, State *

Zip Code *

Credit Card Number (Only used if equipment is not returned) *

Expiration Date (MM/DD) *

Security Code (3 digits next to signature - or 4 digits on the front of Amex) *
I hereby authorize Southeast Scuba Escape, LLC to charge this card for damaged, uncleaned, unreturned equipment, and the cost of late returned equipment at the per day cost, as agreed in this document.*
Yes

Certification Number and Agency (PADI, SSI, NAUI, SDI, etc). If you are a student enter "STUDENT" *
First Rentor/Participant's Signature*
Second Rentor/Participant's Name

First Name*

Last Name*
Second Rentor/Participant's Date of Birth*
Second Rentor/Participant's Information

Street Address *

City, State *

Zip Code *

Credit Card Number (Only used if equipment is not returned) *

Expiration Date (MM/DD) *

Security Code (3 digits next to signature - or 4 digits on the front of Amex) *
I hereby authorize Southeast Scuba Escape, LLC to charge this card for damaged, uncleaned, unreturned equipment, and the cost of late returned equipment at the per day cost, as agreed in this document.*
Yes

Certification Number and Agency (PADI, SSI, NAUI, SDI, etc). If you are a student enter "STUDENT" *
Third Rentor/Participant's Name

First Name*

Last Name*
Third Rentor/Participant's Date of Birth*
Third Rentor/Participant's Information

Street Address *

City, State *

Zip Code *

Credit Card Number (Only used if equipment is not returned) *

Expiration Date (MM/DD) *

Security Code (3 digits next to signature - or 4 digits on the front of Amex) *
I hereby authorize Southeast Scuba Escape, LLC to charge this card for damaged, uncleaned, unreturned equipment, and the cost of late returned equipment at the per day cost, as agreed in this document.*
Yes

Certification Number and Agency (PADI, SSI, NAUI, SDI, etc). If you are a student enter "STUDENT" *
Fourth Rentor/Participant's Name

First Name*

Last Name*
Fourth Rentor/Participant's Date of Birth*
Fourth Rentor/Participant's Information

Street Address *

City, State *

Zip Code *

Credit Card Number (Only used if equipment is not returned) *

Expiration Date (MM/DD) *

Security Code (3 digits next to signature - or 4 digits on the front of Amex) *
I hereby authorize Southeast Scuba Escape, LLC to charge this card for damaged, uncleaned, unreturned equipment, and the cost of late returned equipment at the per day cost, as agreed in this document.*
Yes

Certification Number and Agency (PADI, SSI, NAUI, SDI, etc). If you are a student enter "STUDENT" *
Fifth Rentor/Participant's Name

First Name*

Last Name*
Fifth Rentor/Participant's Date of Birth*
Fifth Rentor/Participant's Information

Street Address *

City, State *

Zip Code *

Credit Card Number (Only used if equipment is not returned) *

Expiration Date (MM/DD) *

Security Code (3 digits next to signature - or 4 digits on the front of Amex) *
I hereby authorize Southeast Scuba Escape, LLC to charge this card for damaged, uncleaned, unreturned equipment, and the cost of late returned equipment at the per day cost, as agreed in this document.*
Yes

Certification Number and Agency (PADI, SSI, NAUI, SDI, etc). If you are a student enter "STUDENT" *
Sixth Rentor/Participant's Name

First Name*

Last Name*
Sixth Rentor/Participant's Date of Birth*
Sixth Rentor/Participant's Information

Street Address *

City, State *

Zip Code *

Credit Card Number (Only used if equipment is not returned) *

Expiration Date (MM/DD) *

Security Code (3 digits next to signature - or 4 digits on the front of Amex) *
I hereby authorize Southeast Scuba Escape, LLC to charge this card for damaged, uncleaned, unreturned equipment, and the cost of late returned equipment at the per day cost, as agreed in this document.*
Yes

Certification Number and Agency (PADI, SSI, NAUI, SDI, etc). If you are a student enter "STUDENT" *
Seventh Rentor/Participant's Name

First Name*

Last Name*
Seventh Rentor/Participant's Date of Birth*
Seventh Rentor/Participant's Information

Street Address *

City, State *

Zip Code *

Credit Card Number (Only used if equipment is not returned) *

Expiration Date (MM/DD) *

Security Code (3 digits next to signature - or 4 digits on the front of Amex) *
I hereby authorize Southeast Scuba Escape, LLC to charge this card for damaged, uncleaned, unreturned equipment, and the cost of late returned equipment at the per day cost, as agreed in this document.*
Yes

Certification Number and Agency (PADI, SSI, NAUI, SDI, etc). If you are a student enter "STUDENT" *
Eighth Rentor/Participant's Name

First Name*

Last Name*
Eighth Rentor/Participant's Date of Birth*
Eighth Rentor/Participant's Information

Street Address *

City, State *

Zip Code *

Credit Card Number (Only used if equipment is not returned) *

Expiration Date (MM/DD) *

Security Code (3 digits next to signature - or 4 digits on the front of Amex) *
I hereby authorize Southeast Scuba Escape, LLC to charge this card for damaged, uncleaned, unreturned equipment, and the cost of late returned equipment at the per day cost, as agreed in this document.*
Yes

Certification Number and Agency (PADI, SSI, NAUI, SDI, etc). If you are a student enter "STUDENT" *
Ninth Rentor/Participant's Name

First Name*

Last Name*
Ninth Rentor/Participant's Date of Birth*
Ninth Rentor/Participant's Information

Street Address *

City, State *

Zip Code *

Credit Card Number (Only used if equipment is not returned) *

Expiration Date (MM/DD) *

Security Code (3 digits next to signature - or 4 digits on the front of Amex) *
I hereby authorize Southeast Scuba Escape, LLC to charge this card for damaged, uncleaned, unreturned equipment, and the cost of late returned equipment at the per day cost, as agreed in this document.*
Yes

Certification Number and Agency (PADI, SSI, NAUI, SDI, etc). If you are a student enter "STUDENT" *
Tenth Rentor/Participant's Name

First Name*

Last Name*
Tenth Rentor/Participant's Date of Birth*
Tenth Rentor/Participant's Information

Street Address *

City, State *

Zip Code *

Credit Card Number (Only used if equipment is not returned) *

Expiration Date (MM/DD) *

Security Code (3 digits next to signature - or 4 digits on the front of Amex) *
I hereby authorize Southeast Scuba Escape, LLC to charge this card for damaged, uncleaned, unreturned equipment, and the cost of late returned equipment at the per day cost, as agreed in this document.*
Yes

Certification Number and Agency (PADI, SSI, NAUI, SDI, etc). If you are a student enter "STUDENT" *
Parent or Guardian's Email Address

Email*

Confirm Email*
Check to receive information, news, and discounts by e-mail.
Rental Equipment Order Form

Pick-up Date. We are closed on Sundays and Mondays. Pick-up is only available during shop hours. *

Return Date (We are closed Sundays and Mondays) If you are in a class, Sunday you may return equipment at the end of class. Weekend rentals picked up Friday are due back the following Tuesday. *
Aqualung Pro-HD BCD
Weights
Hard Weights
Soft Weights
Weight Belt

If needed, how much weight?
Air Tank
Regulator Set (1st, 2nd, Octo, SPG)
Men's Wetsuit 3-5MM (Best Guess on Size)
Men's 7MM Wetsuit (Best Guess on Size)
Women's Wetsuit 3-5MM (Best Guess on Size)
Women's Wetsuit 7MM (Best Guess on Size)
Gloves (Size S-M)
Gloves (Size L-XL+)
Hood (Sizes S-M)
Hood (Sizes L-XL)
Computer Rental
Aqualung i330
Shearwater Teric or Perdix
Shearwater Peregrine
Shearwater Tern
Apeks DSX Computer
Do you need a gear bag for your rental gear? Only mark NO if you have your own gear bag.*
No
Yes

Anything we need to know about your rental needs?
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*

Relationship*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Information

Street Address *

City, State *

Zip Code *

Credit Card Number (Only used if equipment is not returned) *

Expiration Date (MM/DD) *

Security Code (3 digits next to signature - or 4 digits on the front of Amex) *
I hereby authorize Southeast Scuba Escape, LLC to charge this card for damaged, uncleaned, unreturned equipment, and the cost of late returned equipment at the per day cost, as agreed in this document.*
Yes

Certification Number and Agency (PADI, SSI, NAUI, SDI, etc). If you are a student enter "STUDENT" *
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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