RELEASE OF LIABILITY, WAIVER OF CLAIMS, EXPRESS ASSUMPTION OF
RISK AND INDEMNITY AGREEMENT FOR RECREATIONAL, TECHNICAL AND
OVERHEAD ENVIRONMENT DIVING PLEASE READ AND BE CERTAIN YOU
UNDERSTAND THE IMPLICATIONS OF SIGNING THIS RECREATIONAL, TECHNICAL
AND OVERHEAD ENVIRONMENT DIVING RELEASE. EXPRESS ASSUMPTION OF RISK
ASSOCIATED WITH RECREATIONAL, TECHNICAL AND OVERHEAD ENVIRONMENT
DIVING AND RELATED ACTIVITIES
I, hereby affirm and acknowledge that I
have been fully informed of the unique and inherent hazards of
Recreational, Technical and Overhead Environment Scuba Diving
activities. I fully understand that Recreational, Technical and
Overhead Environment Scuba Diving with compressed air, oxygen or
multiple mixed gases involves certain inherent risks including, but
not limited to decompression sickness, embolism, oxygen toxicity,
narcosis, barotrauma and hyperbaric injuries that can lead to
serious permanent injury and even loss of life. I understand that
diving operations may be conducted at a site that is remote from a
recompression chamber and competent medical assistance.
Nevertheless, I choose to proceed even in the absence of a
recompression chamber and competent medical assistance.
Additionally, I understand that there are also risks associated
with dive travel, including, but not limited to the possible injury
or loss of life as a result of a dive boat accident, as well as
travel to and from dive sites.
Despite the potential unique hazards
and dangers associated with the activity of Recreational, Technical
and Overhead Environment Scuba Diving, I wish to proceed and I
freely accept and expressly assume all risk, dangers and hazards
that may arise from Recreational, Technical and Overhead
Environment diving activities which could result in personal
injury, loss of life and property damage to me.
RELEASE OF LIABILITY WAIVER OF
CLAIMS AND INDEMNITY AGREEMENT
In consideration of being allowed to participate in this
Recreational, Technical and Overhead Environment Scuba Diving
course of instruction, as well as the use of any of the facilities
and the use of the equipment of the below listed Releasees, I
hereby agree as follows:
1. TO WAIVE AND RELEASE ANY AND ALL
CLAIMS based upon negligence, active or passive, with the exception
of intentional, wanton or willful misconduct that I may have in the
future against any of the following named persons or entities
(hereafter referred to as
“Releasees”);
Certification Organization: UTD International LLC.
DBA: Unified Team Diving
Instructors:
UTD Instructors Email:
Facility/ies:
Others Parties:
2. To release the Releasees, their officers, directors, employees,
representatives, agents and volunteers, from any liability and
responsibility, whatsoever for any claims or causes of action that
I, my estate, heirs, executors or assigns, may have for personal
injury, property damage or wrongful death arising from
Recreational, Technical and Overhead Environment Scuba Diving
activities, whether caused by active or passive negligence of the
Releasees or otherwise. By executing this document, I agree to save
and hold harmless the Releasees from any claim or lawsuit by me, my
family, estate, heirs or assigns arising out of my participation in
this Recreational, Technical and Overhead Environment Scuba Diving
course, including both claims arising during the course or after I
have received my certification.
3. I fully understand that
Recreational, Technical and Overhead Environment Scuba Diving
activities are physically strenuous and I will be exerting myself
during this course of instruction. I understand and agree that if I
am injured or killed as a result of heart attack, panic,
hyperventilation, oxygen toxicity, narcosis, drowning or any other
cause that I expressly assume the risk of these injuries and/or
attended death and that I will not hold the Releasees included in
this agreement responsible in any other way.
4. By entering into this Agreement I
am not relying on any oral or written representations or statements
made by the Releasees, other than what is set forth in this
Agreement. I further agree that this Agreement shall be governed
by, and interpreted in accordance with the laws of the State of
California, United States of America.
5. If any provision, section,
subsection, clause or phrase of this release is found to be
unenforceable or invalid, that portion shall be severed from this
contract. The remainder of this contract will then be construed as
though the unenforceable portion had never been contained in this
document.
(Complete if you are enrolled in
any UTD Class expect UTD Rec 1.)
I hereby declare that I am a qualified Scuba Diver and have been
truthful in stating my qualifications as a certified Scuba Diver
from the following training agency and that I am aware of the required certification
or equivalent experience. I have been a certified diver since
and I have conducted a total of
dives to a maximum depth of feet or
meters.
I fully understand that the terms of
this Agreement are contractual in nature and not a mere recital. I
further state by way of my signature I have signed this Agreement
of my own free act. I also declare that I am of legal age and
competent to sign this Agreement.
STOP!!! Print before
submitting.
By electronically submitting this form I agree that all contents
are true and that I am bound by it as if I had signed it in
person.
I HAVE READ THIS AGREEMENT, I
UNDERSTAND IT, AND AGREE TO BE BOUND BY IT.
(Print it and Sign it in font of your UTD
Instructor)
Signature of Participant:
__________________________________________________
Date: _______________
Witness:_______________________________________________________________
Date: _______________
I am a minor and my parent or
guardian has signed below.
Signature of parent or guardian
if Participant is a Minor, and by their signature they, on my
behalf release all claims that they and i have.:
______________________________________________________________________
Printed Name:
_________________________________________________________
Date:
___________________
INSTRUCTOR/LEADER CONFIRMATION
I HAVE REVIEWED THIS AGREEMENT AND
CONFIRM THAT IT HAS BEEN PROPERLY COMPLETED.
Signature Of
Instructor/Leader:_____________________________________________
Date: ________________
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