DIVE ANIMALS SCUBA CLUB MEMBERSHIP APPLICATION / LIABILITY RELEASE

_____ New Member _____ Renewal

Name____________________________________________Address__________________________________
City _____________________ State _____ Zip _______ Phone ______________(h) Phone _____________(w)
Internet Address _____________________________________________________
Emergency Contact  ____________________________________ Phone _________________
Certification Level ______________________ Agency ___________
# Logged Dive _______ Put your name on the dive buddy list? ______

Liability Release and Express Assumption of Risk
This is a release of your rights to sue the Dive Animals Scuba Club, it's employees, agents and assigns, its directors, officers and
members, and all Divemasters and Instructors connected with the Dive Animals Scuba Club and/or all forthcoming club or diving
activities (hereinafter referred to as "released parties") for personal injuries or wrongful deaths that may occur during the
forthcoming activities for any reason, including as a result of the inherent risks associated with scuba diving/snorkeling or as a
result of negligence.

(Please place your initials next to each of the following sections)
_____1. I acknowledge that I am a certified scuba diver trained in safe diving practices.
_____2. I am aware of the risks inherent in this sport and accept these risks.
_____3. I affirm that I am in good mental and physical fitness for diving, and 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/drugs.
_____4. I am aware of the dangers of breath holding while scuba diving, and I will not hold the released parties responsible if I
am injured doing so.
_____5. I am aware that I will be diving with a buddy, and it will be our responsibility to plan our dive allowing for our diving
limitations and the prevailing water conditions. I will not hold the released parties responsible for my failure to safely plan.
_____6. I will inspect all of my equipment prior to any diving activities. I will not hold the released parties responsible for my
failure to inspect my equipment prior to diving.
_____7. I acknowledge that I am physically fit to scuba dive/snorkel, and I will not hold the released parties responsible if I am
injured as a result of heart, lung, ear, or circulatory problems or other illnesses that occur while diving and/or snorkeling.
_____8. I understand that even though I follow all of the appropriate dive practices, there is still some risk of of my sustaining
decompression sickness, embolism or other hyperbaric injuries, and I expressly assume the risk of said injuries.
_____9. I also expressly assume the risk and accept all responsibility to plan my dive and dive my plan.
_____10. I also understand that scuba diving/snorkeling is a physically strenuous activity and that I will be exerting myself during
diving, and then if I am injured as a result of a 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.
_____11. I also understand while diving, I will be at a remote site and that there will not be immediate medical care or hyperbaric
care available to me, and I expressly assume the risk of diving in such a remote spot.
_____12. If I am operating or utilizing the Dive Animal Scuba Club boats, I expressly assume all risks involved with such
operation or usage, for any reason and do not hold the released parties responsible for any accident, injury or wrongful death
including negligence.
______13. It is the intention of (Diver's Name) __________________________ by this instrument to exempt and release the
released parties and all related entities 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 the liability release and express assumption of risk by reading it before
I signed it on behalf of myself or my heirs.


Diver's Signature ____________________________________________________ Date ____________________