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DIVER, SNORKELER & PASSENGER REGISTRATION FORM

SCUBA DIVING, SNORKELING AND BOAT TRAVEL

LIABILITY RELEASE AND ASSUMPTION OF RISK AGREEMENT

Please read carefully and fill in all blanks before signing.

I hereby affirm that I am aware that snorkeling and scuba diving have inherent risks which may result in serious injury or death and that:

  • I am a snorkeler, passenger, or, if diving, a certified diver trained in safe diving practices or a student diver under the control and supervision of a certified instructor.
  • I thoroughly understand the hazards of snorkeling and scuba diving with compressed air, including those hazards occurring during vehicle or boat travel to and from the dive site/s. I understand that these hazards include, but are not limited to, air expansion injuries, drowning, decompression sickness, being injured in a car accident, 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 perils of the sea. I certify that I am fully aware of and expressly assume these and all other risks involved in snorkeling and/or making such a dive or dives, whether as a recreational dive or part of a diving class.
  • I understand that I will be at remote site(s) and that there will not be immediate medical or hyperbaric care available to me. I expressly assume the risk of snorkeling/diving in such a remote spot.
  • I am in good mental and physical fitness for diving, and I am not under the influence of alcohol, nor am I under the influence of any drugs that are contraindicatory to diving. If I am taking medication, I affirm that I have seen a physician and have approval to dive while under the influence of the medication/drugs. It would be entirely my responsibility if I were to ask for and take any medication from the company's staff members.
  • I understand that snorkeling/scuba diving is a physically strenuous activity and that I will be exerting myself during this activity, and that if I am injured because of a heart attack, panic, hyperventilation, drowning, breath holding, or any other cause, that I expressly assume the risk of said injuries. And that I will not hold the Released Parties (see below) responsible for the same.
  • I acknowledge that I am physically fit for snorkeling/scuba diving, and I understand that there is still some risk of me being injured because of heart, lung, ear, or circulatory problems or other illnesses that occur while snorkeling/diving, and I expressly assume the risk of said injuries. I am aware that diving is not recommended for pregnant women or elder persons over 70 years of age with cardiac affections.
  • I am aware that I (if a certified diver) will be diving with a buddy, and it will be our responsibility to plan our dive allowing for our diving limitations and the prevailing water conditions. I expressly assume the risk and accept all responsibilities to plan and dive my plan.
  • I have been provided, reviewed, and used all necessary safety gear to carry out the contracted activity, and the service provider has carried out all needed and sufficient actions to safeguard my physical and mental security and integrity. I agree that the use of a life jacket is mandatory during aquatic activities.
  • I will inspect all my equipment before the activity and will notify Cozumel Dive Academy if any of my equipment is not working properly.

I understand and agree that neither Cozumel Dive Academy, Cozumel Dive Center, Dive Boutique Cozumel, the crew or owner of the vessel used by Cozumel Dive Center, nor International PADI Inc., or the owners, officers, instructors, employees, agents, or assigns of the above-listed entities (hereinafter 'Released Parties") may be held liable or responsible in any way for any occurrence on this dive trip(s) 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/s, diving class, and snorkeling or scuba dive(s) or as a result of the negligence of any party, including the Released Parties, whether passive or active.

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 document 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, BY THIS INSTRUMENT, AGREE TO HEREBY EXEMPT AND RELEASE ALL THE ABOVE-LISTED ENTITIES FROM ALL LIABILITY OR RESPONSIBILITY WHATSOEVER 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 HAVE FULLY INFORMED MYSELF OF THE CONTENTS OF THIS LIABILITY RELEASE AND ASSUMPTION OF RISK AGREEMENT BY READING IT BEFORE I SIGNED IT ON BEHALF OF MYSELF AND MY HEIRS.

In other words, by signing below, I am giving up the right to sue Cozumel Dive Academy for any Injury, death, or loss of any kind caused by an accident while I am participating in the activity, including transportation and transit to and from the activity. This means that I am giving up the right to sue Cozumel Dive Academy for negligence, including negligence outside of the activity's inherent risks.

For everything related to interpretation, fulfillment, and implementation of this document where it Is stated the will of the company and the person contracting the activity, the parties subject to the applicable law and jurisdiction of the competent course of Mexico, expressly renouncing to any, forum, court, privilege, or action that they might be entitled to, regarding their current or future address or nationality.

Today's Date: June 14, 2024


First Participant's Name

First Name*

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Information
Diver
Snorkeler
Passenger
Student
Paddle Boarder/Kayaker

Date of Arrival *

Date of Departure *

Hotel/Ship Name *

Room # *

Divers only:


Dive Insurance?*
No
Yes

Divers Insurance Information

Certifying Agency

Certification Level

Certification #

Date & Location of Last Dive

Total # of Dives
First Participant's Signature*
Second Participant's Name

First Name*

Last Name*
Second Participant's Date of Birth*
Second Participant's Information
Diver
Snorkeler
Passenger
Student
Paddle Boarder/Kayaker

Date of Arrival *

Date of Departure *

Hotel/Ship Name *

Room # *

Divers only:


Dive Insurance?*
No
Yes

Divers Insurance Information

Certifying Agency

Certification Level

Certification #

Date & Location of Last Dive

Total # of Dives
Third Participant's Name

First Name*

Last Name*
Third Participant's Date of Birth*
Third Participant's Information
Diver
Snorkeler
Passenger
Student
Paddle Boarder/Kayaker

Date of Arrival *

Date of Departure *

Hotel/Ship Name *

Room # *

Divers only:


Dive Insurance?*
No
Yes

Divers Insurance Information

Certifying Agency

Certification Level

Certification #

Date & Location of Last Dive

Total # of Dives
Fourth Participant's Name

First Name*

Last Name*
Fourth Participant's Date of Birth*
Fourth Participant's Information
Diver
Snorkeler
Passenger
Student
Paddle Boarder/Kayaker

Date of Arrival *

Date of Departure *

Hotel/Ship Name *

Room # *

Divers only:


Dive Insurance?*
No
Yes

Divers Insurance Information

Certifying Agency

Certification Level

Certification #

Date & Location of Last Dive

Total # of Dives
Fifth Participant's Name

First Name*

Last Name*
Fifth Participant's Date of Birth*
Fifth Participant's Information
Diver
Snorkeler
Passenger
Student
Paddle Boarder/Kayaker

Date of Arrival *

Date of Departure *

Hotel/Ship Name *

Room # *

Divers only:


Dive Insurance?*
No
Yes

Divers Insurance Information

Certifying Agency

Certification Level

Certification #

Date & Location of Last Dive

Total # of Dives
Sixth Participant's Name

First Name*

Last Name*
Sixth Participant's Date of Birth*
Sixth Participant's Information
Diver
Snorkeler
Passenger
Student
Paddle Boarder/Kayaker

Date of Arrival *

Date of Departure *

Hotel/Ship Name *

Room # *

Divers only:


Dive Insurance?*
No
Yes

Divers Insurance Information

Certifying Agency

Certification Level

Certification #

Date & Location of Last Dive

Total # of Dives
Seventh Participant's Name

First Name*

Last Name*
Seventh Participant's Date of Birth*
Seventh Participant's Information
Diver
Snorkeler
Passenger
Student
Paddle Boarder/Kayaker

Date of Arrival *

Date of Departure *

Hotel/Ship Name *

Room # *

Divers only:


Dive Insurance?*
No
Yes

Divers Insurance Information

Certifying Agency

Certification Level

Certification #

Date & Location of Last Dive

Total # of Dives
Eighth Participant's Name

First Name*

Last Name*
Eighth Participant's Date of Birth*
Eighth Participant's Information
Diver
Snorkeler
Passenger
Student
Paddle Boarder/Kayaker

Date of Arrival *

Date of Departure *

Hotel/Ship Name *

Room # *

Divers only:


Dive Insurance?*
No
Yes

Divers Insurance Information

Certifying Agency

Certification Level

Certification #

Date & Location of Last Dive

Total # of Dives
Ninth Participant's Name

First Name*

Last Name*
Ninth Participant's Date of Birth*
Ninth Participant's Information
Diver
Snorkeler
Passenger
Student
Paddle Boarder/Kayaker

Date of Arrival *

Date of Departure *

Hotel/Ship Name *

Room # *

Divers only:


Dive Insurance?*
No
Yes

Divers Insurance Information

Certifying Agency

Certification Level

Certification #

Date & Location of Last Dive

Total # of Dives
Tenth Participant's Name

First Name*

Last Name*
Tenth Participant's Date of Birth*
Tenth Participant's Information
Diver
Snorkeler
Passenger
Student
Paddle Boarder/Kayaker

Date of Arrival *

Date of Departure *

Hotel/Ship Name *

Room # *

Divers only:


Dive Insurance?*
No
Yes

Divers Insurance Information

Certifying Agency

Certification Level

Certification #

Date & Location of Last Dive

Total # of Dives
Parent or Guardian's Email Address

Email*

Confirm Email*
Emergency Contact

First Name*

Last Name*

Emergency Contact's Phone Number*
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 Information
Diver
Snorkeler
Passenger
Student
Paddle Boarder/Kayaker

Date of Arrival *

Date of Departure *

Hotel/Ship Name *

Room # *

Divers only:


Dive Insurance?*
No
Yes

Divers Insurance Information

Certifying Agency

Certification Level

Certification #

Date & Location of Last Dive

Total # of Dives
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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