R-1, 2020-07-29

NOTE: Waterhorse Charters does not accept paper waivers, please submit electronically.

Voluntary Release, Waiver, and Assumption of Risk

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

I understand that diving with compressed air involves certain inherent risks; decompression sickness, embolism, or other hyperbaric injuries can occur that requires treatment in a recompression chamber. I further understand that this program may be conducted at a site that is remote, either by time or distance or both, from such a recompression chamber. I still choose to proceed with this program in spite of the absence of a recompression chamber in proximity to the dive site.

The information I have provided about my medical history on the Medical Questionnaire is accurate to the best of my knowledge. I agree to accept responsibility for omissions regarding my failure to disclose any existing or past health conditions.

I understand and agree that neither the dive professionals conducting this program, nor the facility through which this activity is conducted, Waterhorse Charters, nor its affiliate or subsidiary corporations, nor any of their respective employees, officers, agents or assigns (hereinafter referred to as “Released Parties”) may be held liable or responsible in any way for any injury, death or other damages to me, my family, estate, heirs or assigns that may occur as a result of my participation in this program or as a result of the negligence of any party, including the Released Parties, whether passive or active.

In consideration of being allowed to participate in this program, I hereby personally assume all risks for any harm, injury or damage, whether foreseen or unforeseen, that may befall me while participating in this program, including but not limited to the knowledge development, confined water and/or open water activities.

I further release and hold harmless the Discover Scuba Diving program and the Released Parties from any claim or lawsuit by me, my family, estate, heirs or assigns, arising out of my participation in this program.

I further understand that skin diving and scuba diving are physically strenuous activities and that I will be exerting myself during this program and that if I am injured as a result of heart attack, panic, hyperventilation, etc. that I expressly assume the risk of said injuries and that I will not hold the Released Parties responsible for the same.

I further state that I am of lawful age and legally competent to sign this Liability Release and Assumption of Risk Agreement, or that I have acquired the written consent of my parent or guardian.

I understand that the terms herein are contractual and not a mere recital and that I have signed this Agreement of my own free act and with the knowledge that I hereby agree to waive my legal rights. I further agree that 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 understand and agree that I am not only giving up my right to sue the Released Parties but also any rights my heirs, assigns, or beneficiaries may have to sue the Released Parties resulting from my death. I further represent that I have the authority to do so and that my heirs, assigns, or beneficiaries will be estopped from claiming otherwise because of my representations to the Released Parties.

BY THIS INSTRUMENT DO EXEMPT AND RELEASE THE DIVE PROFESSIONALS CONDUCTING THIS ACTIVITY, THE FACILITY THROUGH WHICH THIS ACTIVITY IS CONDUCTED, AND ALL RELATED ENTITIES AND RELEASED PARTIES AS DEFINED ABOVE, FROM ALL LIABILITY OR RESPONSIBILITY WHATSOEVER FOR PERSONAL INJURY, PROPERTY DAMAGE OR WRONGFUL DEATH, HOWEVER CAUSED, INCLUDING BUT NOT LIMITED TO 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 SIGNING IT ON BEHALF OF MYSELF AND MY HEIRS AND AFFIRM THE MEDICAL QUESTIONNAIRE IS ACCURATE.


Emergency Contact Information:


Flying After Diving Recommendations:

1) For single dives within the no-decompression limits, a minimum pre-flight surface interval of 12 hours is suggested.

2) For repetitive dives and/or multi-day dives within the no-decompression limits, a minimum preflight surface interval of 18 hours is suggested.

3) For dives requiring decompression stops, a minimum preflight surface interval greater than 18 hours is suggested.

Click to Initial
Initial


Medical Questionnaire:

Scuba diving is an exciting and demanding activity. To scuba dive safely, you must not be extremely overweight or out of condition. Diving can be strenuous under certain conditions. Your respiratory and circulatory systems must be in good health. All body air spaces must be normal and healthy. A person with heart trouble, a current cold or congestion, epilepsy, asthma, a severe medical problem, or who is under the influence of alcohol or drugs, should not dive. If taking medication, consult your doctor before participating in this program.

The purpose of this Medical Questionnaire is to find out if you should be examined by a physician before participating in recreational scuba diving. An existing condition or history of condition does not necessarily disqualify you from diving. An existing condition or history of the condition means that there is a preexisting condition that may affect your safety while diving and you must seek the advice of a physician.

Please read the items below and indicate if any of those apply to your past and/or present medical history. If you are not sure or if any of these items do apply to you, we must request that you consult with a physician prior to participating in scuba diving.

- I currently have an ear infection.

- I have a history of ear disease, hearing loss, or problems with balance.

- I have a history of ear or sinus surgery.

- I am currently suffering from a cold, congestion, sinusitis or bronchitis.

- I have a history of respiratory problems, severe attacks of hay fever or allergies, or lung disease.

- I have had a collapsed lung (pneumothorax) or a history of chest surgery.

- I have active asthma or a history of emphysema or tuberculosis.

- I am currently taking medication that carries a warning about any impairment of my physical or mental abilities.

- I have behavioral health, mental or psychological problems or a nervous system disorder.

- I am or could be pregnant.

- I have a history of colostomy.

- I have a history of heart disease or heart attack, heart surgery or blood vessel surgery.

- I have a history of high blood pressure, angina, or take medication to control blood pressure.

- I am over 45 and have a family history of heart attack or stroke.

- I have a history of bleeding or other blood disorders.

- I have a history of diabetes.

- I have a history of seizures, blackouts or fainting, convulsions or epilepsy or take medications to prevent them.

- I have a history of back, arm or leg problems following an injury, fracture or surgery.

- I have a history of fear of closed or open spaces or panic attacks (claustrophobia or agoraphobia).

Your initial here indicates you haven't experienced and are not currently experiencing any of the conditions aforementioned, meaning you're apt to participate in the Discover Scuba Diving activity. If you are not sure or if any of these items do apply to you, we must request that you consult with a physician prior to participating in scuba diving.

Click to Initial
Initial


Discover Scuba Diving Knowledge and Safety Review:

To continue with your Discover Scuba Diving experience, you must complete this review before getting in the water:

1. Upon completing this experience, I will be qualified to dive independently without a certified professional guiding me.

2. To equalize my ears and sinus air spaces during descent, I will need to blow gently against pinched nostrils.

3. I should equalize every few feet/one meter while descending.

4. If I have discomfort in my ears or sinuses during descent, I should continue downward.

5. Underwater, I should breathe slowly, deeply, continuously and never hold my breath.

6. I should add air to my buoyancy control device (BCD) to float at the surface.

7. The “caution zone” on my air gauge indicates that I have plenty of air in my tank and that I may continue diving.

8. I should not touch, tease or harass an underwater organism since I may harm it or it may harm me.

9. I should stay close to the PADI Professional during my Discover Scuba Diving experience and signal if something is wrong.

Your initial here indicates you have understood and agreed with the aforementioned conditions.

Click to Initial
Initial


COVID-19:

Waterhorse Charters, Inc d/b/a Waterhorse Charters has put in place an extensive protocol with preventative measures to reduce the spread of COVID-19, however, we cannot guarantee that you will not become infected with COVID-19. Further, participating in this activity could increase your risk of contracting COVID-19.

I ACKNOWLEDGE THE CONTAGIOUS NATURE OF COVID-19 AND VOLUNTARILY ASSUME THE RISK THAT I MAY BE EXPOSED TO OR INFECTED BY COVID-19 BY PARTICIPATING ON ANY ACTIVITIES AND THAT SUCH EXPOSURE OR INFECTION MAY RESULT IN PERSONAL INJURY, ILLNESS, PERMANENT DISABILITY, AND DEATH. I UNDERSTAND THAT THE RISK OF BECOMING EXPOSED TO OR INFECTED BY COVID-19 AT WATERHORSE CHARTERS, INC D/B/A WATERHORSE CHARTERS MAY RESULT FROM THE ACTIONS, OMISSIONS, OR NEGLIGENCE OF MYSELF AND OTHERS, INCLUDING, BUT NOT LIMITED TO, EMPLOYEES AND ACTIVITIES PARTICIPANTS AND THEIR FAMILIES. I VOLUNTARILY AGREE TO ASSUME ALL OF THE FOREGOING RISKS AND ACCEPT SOLE RESPONSIBILITY FOR ANY INJURY TO MYSELF (INCLUDING, BUT NOT LIMITED TO, PERSONAL INJURY, DISABILITY, AND DEATH), ILLNESS, DAMAGE, LOSS, CLAIM, LIABILITY, OR EXPENSE, OF ANY KIND, THAT I MAY EXPERIENCE OR INCUR IN CONNECTION WITH MY PARTICIPATION IN ANY ACTIVITY (“CLAIMS”). ON MY BEHALF, AND ON BEHALF OF MY CHILDREN, I HEREBY RELEASE, COVENANT NOT TO SUE, DISCHARGE, AND HOLD HARMLESS WATERHORSE CHARTERS, INC D/B/A WATERHORSE CHARTERS, ITS EMPLOYEES, AGENTS, AND REPRESENTATIVES, OF AND FROM THE CLAIMS, INCLUDING ALL LIABILITIES, CLAIMS, ACTIONS, DAMAGES, COSTS OR EXPENSES OF ANY KIND ARISING OUT OF OR RELATING THERETO. I UNDERSTAND AND AGREE THAT THIS RELEASE INCLUDES ANY CLAIMS BASED ON THE ACTIONS, OMISSIONS, OR NEGLIGENCE OF WATERHORSE CHARTERS, INC D/B/A WATERHORSE CHARTERS, ITS EMPLOYEES, AGENTS, AND REPRESENTATIVES, WHETHER A COVID-19 INFECTION OCCURS BEFORE, DURING, OR AFTER PARTICIPATION IN ANY ACTIVITY.


Mandatory for Rental Gear Sizing:

(in ft.)

(in lbs.)


Participant Statement:

I now understand any questions I may have answered incorrectly. I acknowledge and accept that these practices are intended to increase my safety and comfort during the experience.

Click to Sign
Signature

By checking here, you acknowledge you have read and understand the above terms, and 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.