ATLANTIC
BEACH DIVING SERVICES
COMPLETE
LIABILITY RELEASE
1.
I UNDERSTAND THE PURPOSE OF SIGNING THIS DOCUMENT IS TO
EXEMPT AND RELEASE ATLANTIC BEACH DIVING SERVICES, WADE D. BROUGHMAN, AL VOGT,
M/V MUTINY, ITS EMPLOYEES, ITS AGENTS, AND ITS BOATS (WHETHER OWNED, LEASED, OR
CHARTERED) AND TO HOLD THESE ENTITIES HARMLESS FROM ANY AND ALL LIABLILTIES
ARISING AS A CONSEQUENCE OF THE FOLLOWING, OR ANY ACTS OR OMISSIONS ON THEIR
PART, INCLUDING BUT NOT LIMITED TO NEGLIGENCE.
2.
I am a
certified diver or a student diver under the supervision of an instructor and
have been taught and understand that scuba diving has inherent risks and
dangers associated therewith, including but not limited to, risks associated
with my physical fitness and preparedness to dive, diving related injuries and
illnesses, equipment failure, perils of the sea, aquatic animal bites,
stings, or adverse reactions, and acts
of fellow divers, which cause injury or death and I SPECIFICALLY ASSUME SUCH RISKS.
3.
I have been
diving within the past year or am currently participating in a refresher
course, or I am a student under the instruction of a dive professional.
4.
I acknowledge
that I am physically fit to scuba dive and snorkel and I will not hold any of
the above named persons or entities responsible if I am injured as a result of
heart problems, lung problems, or other illnesses or medical problems which
occur while boating, diving, and/or
snorkeling.
5.
I do not have
in my possession any illegal drugs, nor am I taking, nor have I recently
consumed any drugs or medications that are contraindications for diving. I am not under the influence of alcohol, nor
am I suffering its aftereffects (i.e., hung over).
6.
Prior to
leaving the dock, I will inspect all equipment to be used. I will notify the above named persons if any
equipment is not functioning properly. I
will not hold Atlantic Beach Diving Services, Wade D. Broughman, Al Vogt, M/V
Mutiny or any of is employees, agents or boats responsible for my failure to
inspect equipment prior to diving.
7.
I will be
present at and attentive to the safety briefing given by the dive master and
boat captain and if there is anything that I do not understand or have been
taught differently, I will notify the boat captain immediately.
8.
I understand I
have a duty to plan and carry out my own dive and to be responsible for my own
safety and the safety of my buddy. I
WILL REMAIN WITH MY BUDDY AT ALL TIMES.
9.
I will start
my ascent at the end of each dive with enough air to guarantee being on the
boat with a minimum of 500 psi remaining.
10.
I will
immediately stop my dive and return to the boat if I feel uncomfortable with my
diving abilities, and/or if diving conditions are worse than those for which I
have been trained or for which I have experience.
11.
I am aware of
the dangers of holding my breath while diving and of the dangers associated
with rapid ascents and will not hold the above named persons or entities
responsible for such acts and agree to assume these risks.
12.
If I become
distressed, I will IMMEDIATELY make a controlled ascent, drop my weights, inflate
my B.C. for positive flotation assistance and if I want or need assistance from
the boat, I will communicate proper “diver needs assistance” signals.
13.
I fully
understand and am aware that the boat has limited first aid equipment and that
in the event of illnesses or injury, appropriate medical help must be summoned
by radio and that treatment will be delayed until I can be transported to a
proper medical care facility, I agree to assume these risks.
14.
IT IS MY
INTENTION BY SIGNING THIS DOCUMENT TO GIVE UP MY RIGHT TO SUE ALL PERSONS OR
ENTITIES REFERRED TO HEREIN, WHETHER SPECIFICALLY NAMED OR NOT, AND IT IS ALSO
MY INTENTION TO EXEMPT AND RELIEVE ATLANTIC BEACH DIVING SERVICES, WADE D.
BROUGHMAN, AL VOGT, M/V MUTINY, ITS EMPLOYEES, ITS AGENTS, AND ITS BOATS AND TO
HOLD THESE ENTITIES HARMLESS FROM ANY LIABILITY FOR PERSONAL INJURY, PROPERTY
DAMAGE OR WRONGFUL DEATH CAUSED BY NEGLIGENCE OR GROSS NEGLIGENCE. I ASSUME ALL RISKS IN CONNECTION WITH
BOATING, SNORKELING, AND SCUBA DIVING ACTIVITIES.
15.
I HAVE READ
AND UNDERSTAND THE FOREGOING IN ITS ENTIRETY AND AGREE TO THE TERMS AND
CONDITIONS HEREIN ABOVE SET FORTH ON BEHALF OF MYSELF, MY HEIRS, AND MY
PERSONAL REPRESENTATIVES. I SIGN IT OF
MY OWN FREE WILL AND AGREE TO BE BOUND BY IT FROM THE DATE OF MY SIGNATURE
FOREVER INTO THE FUTURE. THERE ARE NO
WARRANTIES, EXPRESSED OR IMPLIED, WHICH EXTEND BEYOND THE DESCRIPTION OF ACTIVITIES
LISTED ON THIS FORM.
Date(s):
__________________________________ Signature:
_______________________________________
Certification Agency: ___________ Cert. #: ____________ Print name: _____________________________________
Local Accommodations:
______________________________Permanent Address: ____________________________
Emergency Contact Name:______________________________________________
Phone Number: _____________
City, State, Zip:
_________________________________________________________________________________
Parent or Guardian:
___________________________ Telephone Number: ______________________________
***Passengers under 18 years of age must also have a
parent’s signature***
Date of last dive:
________________ Total # of dives: ____________ # Ocean dives: _______________
Email address:
_________________________________________________________________________________