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Scuba Diving Liability Release Form


 Aloha and Thank You for choosing Island Style Diving!

You are required to fill out this release for each dive excursion booked. We apologize for the redundancy, but to comply with insurance and smartwaiver policies, a waiver is required each time. Thank you for your patience with this process. We look forward to seeing you soon!

This is a Release Of Your Rights To Sue Island Style Diving LLC and Its Employees, Agents and Assigns For Personal Injuries Or Wrongful Death That May Occur During The Forthcoming Dive Activity As A Result Of The Inherent Risks Associated With Scuba Diving Or As A Result Of Negligence.


Please read and review each statement. You must check “I Agree” to acknowledge that you are aware of the risks.

 

I acknowledge that I am a certified scuba diver trained in safe diving practices.

I Agree

I accept the risks inherent in this sport, including possible injury inflicted by marine animals living in a wild environment and I accept these risks.

I Agree

I affirm that I am in good mental and physical fitness for diving.

I Agree

I affirm that I am not under the influence of alcohol, nor am I under the influence of any drugs that are contradictory 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. 

I Agree

I am aware of the dangers of breath holding while scuba diving, and will not hold Island Style Diving and related entities (employees, instructors, divemasters, boat operators, boat personnel, or dive training agencies) responsible if I am injured doing so. 

I Agree

I am aware it is my responsibility to monitor my own air pressure, depth, and time to keep within safe diving limits appropriate to my skill level, physical fitness, and ocean conditions. I will not hold Island Style Diving and related entities responsible for any failure on my part to observe safe diving practices that lead to injury.

I Agree

I will inspect all of my equipment prior to the activity and will notify boat personnel if any of the equipment (or equipment I am renting) is not working properly. I will not hold Island Style Diving and related entities responsible for my failure to inspect my equipment prior to the dive.

I Agree

I acknowledge that I am physically fit to scuba dive and I will not hold Island Style Diving or related entities responsible if I am injured as a result of heart, circulatory system, or ear problems or other illnesses that occur while diving.

I Agree

I understand that even though I follow all the appropriate dive practices, there is still some risk of sustaining decompression sickness, embolism, or other hyperbaric injuries, and I expressly assume the risk of said injuries.

I Agree

I expressly assume the risk and accept all responsibility to plan my dives and dive my plan.  If I am using a dive computer, I accept the responsibility for diving within its no-decompression limits. 

I Agree

I understand that scuba diving is a strenuous activity and that I will be exerting myself during this excursion, and that if I am injured as a result of a heart attack, panic, hyperventilation, or any other medical condition that I expressly assume the risk of said injuries and I will not hold Island Style Diving or related entities responsible for same.

I Agree

I understand that on this open water diving trip I will be at a remote site and there will not be immediate medical or hyperbaric care available to me, and I expressly assume the risk of diving in such a remote area.  

I Agree

I am aware of the risk of going to altitude withing 24 hours after diving whether by airplane, helicopter, or car and will follow current recommendations and safe practices.

I Agree

*Reminder* Maui’s volcano summit HALEAKALA is 10,000 feet/ 3,055 meters


It Is The Intention Of The Party Filling Out This Document That By This Instrument To Exempt And Release Island Style Diving, Its Owners, Employees, And All Related Entities As Defined Above, From All Liability Whatsoever For Personal Injury, Property Damage, Or Wrongful Death Caused By Negligence.


I Have Fully Informed Myself Of The Contents Of This information And Release By Reading It Before I Signed It On Behalf Of Myself Or My Heirs.

I Agree


ATTATCHMENT B

PRE-TRIP BRIEFING AND ACKNOWLEDGE FORM

Molokini Shoal Life Conservation District Use Permit*

 

Molokini Islet is the southern rim of an extinct volcanic crater. The shallow inner cove is the crater’s submerged floor which is covered by sand patches, coral, and boulders. The coral reefs within the crater support abundant marine life which is among the most diverse and impressive in Hawaii.  The waters in and around Molokini are designated as a Marine Life Conservation District (MLCD), which makes it a strictly protected marine reserve. While enjoying your visit to Molokini, please help us to protect this precious area by following these rules and guidelines:

1.     The taking, injuring, or disturbing of any living material (fishes, turtles, eggs, shells, corals, seaweed, etc.) or non-living habitat (sand, rocks, coral skeletons, etc.) is strictly prohibited. Sea Turtles may not be approached or harassed at any time.

2.     Make sure you avoid contacting the bottom at all times and stay out of the shallow water immediately next to shore.  Keep hands and feet well away from any rock or coral, and use a flotation device if you need help swimming or if it is required by your guides.

3.     Feeding fish or introducing any material into the water that could attract marine life is strictly prohibited. Fish feeding can change the type of fish in the reserve, stimulate aggressive behavior, and reduce normal grazing patterns that maintain a healthy reef. 

4.     Stay away from shore and do not attempt to climb onto the island. Molokini is a seabird sanctuary and entry is strictly prohibited. 

5.     Avoid excessive splashing and creating loud noises that can disturb both protected marine life and seabirds. 

6.     It is illegal to pollute or introduce human waste into the MLCD waters.

7.     Listen to your guides, follow their instructions, and do not venture too far away from your tour vessel. Weather and current conditions at Molokini can change very quickly, and this can create dangerous situations if you get separated from your boat.  


I certify that I have read and will comply with all of the rules and guidelines listed above.

I Agree



First Participant's Name

First Name*

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Signature*
Second Participant's Name

First Name*

Last Name*

Phone*
Second Participant's Date of Birth*
Third Participant's Name

First Name*

Last Name*

Phone*
Third Participant's Date of Birth*
Fourth Participant's Name

First Name*

Last Name*

Phone*
Fourth Participant's Date of Birth*
Fifth Participant's Name

First Name*

Last Name*

Phone*
Fifth Participant's Date of Birth*
Sixth Participant's Name

First Name*

Last Name*

Phone*
Sixth Participant's Date of Birth*
Seventh Participant's Name

First Name*

Last Name*

Phone*
Seventh Participant's Date of Birth*
Eighth Participant's Name

First Name*

Last Name*

Phone*
Eighth Participant's Date of Birth*
Ninth Participant's Name

First Name*

Last Name*

Phone*
Ninth Participant's Date of Birth*
Tenth Participant's Name

First Name*

Last Name*

Phone*
Tenth Participant's Date of Birth*
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 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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