ATLANTIC BEACH DIVING SERVICES
COMPLETE
LIABILITY RELEASE
- 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.
- 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.
- 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.
- 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.
- 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).
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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: _____________________ #:
___________ 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:
______________________________________________________