Enrollment Form Scuba Skills Updater.Pub

Recreational Diving

Enrollment Form̶Scuba Skills Update

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What is Included? The Scuba Skills Update session is open to certified scuba divers from any recognized training agency. It encompasses a knowledge review and a skills review in the pool, along with an equipment evaluation to help access the status of your diving equipment. Whatever equipment you are missing or want to replace your dive leader will be able to help you with it.

You should bring your own personal system (mask, fins, snorkel, boots, suit, etc) as well as any other equipment you may already own. If you are missing things, we can help you find the right fit for your safety. We include the BCD, air deliver system unless you have your own as well as the cylinder for your class.

The course fees do not include travel to and from the lectures and dive sites, entrance or charter fees, lodging, meals, gas fills and equipment; these are the student’s responsibility. Additionally, for training and open water sessions outside the immediate area, the students are responsible for the instructors expenses.

Course Fees: Scheduled

Program Club Aquarius Member  $150.00 $75.00 Non-Club Member  $175.00 $100.00 Club Membership (annual) *  $65.00 $65.00 * Club Aquarius is an international club, Oceanic Ventures hosts a Club chapter here in Houston. There are numerous benefits including discounts on training programs.

TRY SCUBA and SCUBA Skills Update – Scheduled the first Saturday of the month or other times by appointment (please RSVP with forms and deposit one week prior.)

Thank you for your signing up for a SCUBA Skills Update. Please plan to be at the store Saturday 10:30AM. Class from 11:00 – noon and then to the pool from noon to 2:30 PM. On a week night, 6:00 PM or earlier for two evenings. Plan to come back to the store to have log signed after the pool sessions.

To reserve a space, please confirm you received this email and that you can attend, returning the medical and the waiver, and copy of your certification card and the course fee. This is needed to schedule staff for the class. If you are unable to attend, your deposit will be refunded, if notified in advance. We ask kindly that there is no refunds for no-shows. The scheduled course includes a $50.00 gift card that you can use to purchase other equipment you need to go diving.

You will find that our focus is not merely teaching diving, but rather focusing on helping people become a divers. I think we offer a little different program and they might find the guide located at http://www.oceanicventures.com/resources/guide.pdf useful .

Anytime you are a student in our care, we need to make sure you are medically fit to dive. Please review the attached medical statement and guidelines. You may need to these forms also reviewed and signed by your doctor and if so will need to have that before coming to class. Also, for your and our dive leader safety, any diving equipment system that requires annual service (air delivery equipment, buoyancy systems, cylinders, and instrumentation) must be in current service to be used in an instructional setting. Please let us know in advance if your equipment service so that we can schedule your update and service together. That way you can test your equipment in the pool before your trip!!! Or you can use our rental equipment for your update pool training. It is included in the fees. We can also assist in updating or fitting you for your personal system.

Your SCUBA Skills Update Program is designed to give you the time you need in the water to feel comfortable again in the water and refresher your basic SCUBA SKILLS. You may find it beneficial to enroll in an Advance Diver program or one of a number of diver specialty courses such as Computer Diving, Nitrox Diver, or Navigation that can be completed at the same time and/or on your trip. Also, you can review the first three chapters of the Open Water course anytime by signing up for the free e-learning thru SSI. Click to the link on our web site., http://oceanicventures.com/recreational-dive-courses/ and below.

Please take the time to complete your home study program ahead of schedule so you can work with your instructor on any material you may have questions about. (You may stop by the store anytime to purchase or borrow a DVD.) Your individual coaching sessions will help you review with your instructor any concerns you may have about your program and also solve any issue with your equipment system. Your instructor will help you design a Total Diving System that best fits your needs as a diver so you are safe and comfortable in the open water. Think about signing up for one of our local Open Water sessions to go diving before your next trip if your schedule allows or one of our professional lead group trips for later in the year.

Plan to be amazed.....you are about to re-enter the underwater world and be with the fish!!!!!!!!!

Open Waters - Beautiful Blue Lagoon The second weekend of each month on Saturday and Sunday.

The next step for SCUBA Skills Updates Students: Once you have completed your SCUBA Skills Update you can start toward your Master Diver Level 4 rating. Ask your instructor how you can become a Master Diver and join the Master Diver Challenge and the chance to win a free trip. Plan to join us at Blue Lagoon the next month as a fun diver and practice your skills, and meet new dive buddies.

Join Club Aquarius - Club Aquarius is an International Diving Club affiliated with SSI. Oceanic Ventures sponsors a local chapter. Membership is $75 pp family for a year and $65 for individuals. Membership benefits include travel discounts, discounts on classes, monthly equipment specials, meetings, door prizes, a card and a gift. Monthly meetings are the third or fourth Thursday of the month starting at 7:00 for beverages and snacks, door prizes, slide show and more. Join the club today!!

Thank you and welcome to the underwater world!!!!

Questions? Call us at 713.523.DIVE. Now, open the Door to Adventure and start down the road to a Lifetime of Adventure and Serious Fun!!!

Waiver and Release of Liability Assumption of Risk and Indemnity Agreement THIS FORM IS TO BE USED FOR ALL DIVING ACTIVITIES OTHER THAN ENTRY-LEVEL TRAINING

I HEREBY acknowledge that SNORKELING/SCUBA DIVING/RECREATIONAL REBREATHER DIVING IS A POTENTIALLY DANGEROUS ▲ PARTICIPANT’S NAME ACTIVITY and involves the risk of serious injury and/or death and/or property damage. I FURTHER ACKNOWLEDGE that diving with compressed gas involves certain risks and injuries that can occur which require treatment in a medical facility and/or recompression chamber. I UNDERSTAND that the open water diving trips, which are necessary for training and certification or for other diving activities may be conducted at a site that is remote, either by time or distance or both, from a recompression chamber or medical facilities.

I HEREBY RELEASE, WAIVE, DISCHARGE AND AGREE NOT TO SUE SSI (Scuba Schools International), the dive center / dive resort ▲ DIVE CENTER/DIVE RESORT/DIVE SCHOOL / dive school ,or any of its officers, instructor agents, dive professional agents or employees (the Releasees) FROM ALL LIABILITY TO MYSELF, my personal representatives, assigns, heirs, and next of kin FOR ANY AND ALL LOSS OR DAMAGE, AND ANY CLAIM OR DEMANDS THEREFORE ON ACCOUNT OF INJURY TO MY PERSON OR PROPERTY OR RESULTING IN MY DEATH, NOW AND FOREVER, ARISING OUT OF OR RELATED TO PARTICIPATION AND/OR INSTRUCTION IN SAID COURSE, ACTIVITIES, OR ANY OTHER RELATED DIVING OPERATIONS THAT MAY OCCUR, WHETHER CAUSED BY THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE.

I HEREBY ASSUME FULL RESPONSIBILITY FOR ANY RISK OF BODILY INJURY, DEATH OR PROPERTY DAMAGE, now and forever, arising out of or related to participation and/or instruction in said course, activities, or any other related diving operations, whether foreseen or unforeseen and whether caused by the negligence of the Releasees or otherwise, I HEREBY SEPARATELY agree to INDEMNIFY and SAVE and HOLD HARMLESS the Releasees from any loss, liability, damage or cost that they may incur, now and forever, arising out of or related to participation and/or instruction in said course, activities, or any other related diving operations, whether caused by the negligence of the Releasees or otherwise.

I HEREBY ACKNOWLEDGE THAT INJURIES RECEIVED MAY BE COMPOUNDED OR INCREASED BY NEGLIGENT RESCUE OPERATIONS OR PROCEDURES OF THE RELEASEES and agree that this Waiver and Release of Liability, Assumption of Risk extends to all acts of negligence by Releasees, INCLUDING NEGLIGENT RESCUE OPERATIONS and is intended to be as broad and inclusive as permitted by the laws of the Province or State in which the activities are conducted and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect.

I UNDERSTAND and agree that SSI Dive Centers, Diving Schools, Resorts their affiliated Dive Professionals, associated with the program in which I am participating, are licensed to use various SSI Trademarks and to conduct SSI training, but are not agents, employees or franchisees of SSI or its parent, subsidiary and affiliated corporations (“SSI”).

I FURTHER UNDERSTAND that the Dive Center, Diving School, Resort and their affiliated Dive Professionals business activities are independent, and are neither owned nor operated by SSI, and that while SSI establishes the standards for SSI diver training programs, it is not responsible for, nor does it have the right to control, the operation of the business activities and the day-to-day conduct of SSI programs and/or supervision of divers by the Dive Center, Diving School, Resort and their affiliated Dive Professionals or their associated staff. I further understand and agree on behalf of myself, my heirs and my estate that in the event of an injury or death during this activity, neither I nor my estate shall seek to hold SSI liable for the actions, inactions or negligence of the Dive Center, Diving School, Resort and their affiliated Dive Professionals and other affiliated personnel associated with the activity.

WAIVER RELEASE VERIFICATION

I HAVE READ this Waiver and Release of Liability, Assumption of Risk and Indemnity Agreement, fully understand its terms, understand that I have given up substantial rights by signing it, am aware of its legal consequences, and have signed it freely and voluntarily without any inducement, assurance, or guarantee being made to me and intend my signature to be a complete and unconditional release of all liability to the greatest extent allowed by law. I have had the opportunity to personally discuss with the dive professional the potential dangers incidental to engaging in the course and/or activity of snorkeling/scuba diving/ recreational rebreather diving and related diving operations. Participant’s Name Date ▲ Name (PLEASE PRINT) ▲ (SIGNATURE REQUIRED) ▲ ( DD / MM / YY )

JUNIOR WAIVER RELEASE VERIFICATION

As parent or guardian, I am signing this document on behalf of my minor child and agree to be specifically bound to all the terms and conditions of this Waiver and Release of Liability, Assumption of Risk and Indemnity Agreement. I have read this Waiver and Release of Liability, Assumption of Risk and Indemnity Agreement, and fully understand the terms herein, understand that I have given up substantial rights by signing it, am aware of its legal consequences, and have signed this document freely and voluntarily without any inducement, assurance or guarantee being made to me. I intend my signature to be a complete and unconditional release of all liability to the greatest extent allowed by law and further agree to indemnify and save and hold harmless Releasees. Additionally, I understand the risks of injury while snorkeling or scuba diving and have had the opportunity to personally discuss the diving activities or instructional program with the dive leader prior to commencement of the minor child’s snorkeling or scuba activities. Junior Participant’s Name ______▲ Name (PLEASE PRINT) Junior's Parent/Guardian’s Name Date ▲ Name (PLEASE PRINT) ▲ (SIGNATURE REQUIRED) ▲ ( DD / MM / YY )

RISK AWARENESS 3 To be signed by participant after viewing RISK AWARENESS VIDEO — PART III and prior to continuing education training dives: Participant’s Name Date ▲ Name (PLEASE PRINT) ▲ (SIGNATURE REQUIRED) ▲ ( DD / MM / YY ) Witness Date ▲ Name (PLEASE PRINT) ▲ (SIGNATURE REQUIRED) ▲ ( DD / MM / YY ) Junior Participant’s Name ______▲ Name (PLEASE PRINT) Junior's Parent/Guardian’s Name Date ▲ Name (PLEASE PRINT) ▲ (SIGNATURE REQUIRED) ▲ ( DD / MM / YY ) ✱ NOTE: This Waiver and Release of Liability, Assumption of Risk and Indemnity Agreement is to be signed by the minor child as a participant, as well as by one or both parents or the guardian. © Concept Systems International GmbH 2013 | Assumption Of Risk Waiver - OTHER THAN ENTRY 1505SINGLE | v100313 Model & Property Release

By way of my signature on this document, and in consideration for allowing my participation in this event, trip or course, which is being offered by Oceanic Ventures, Inc., I hereby irrevocably authorize Oceanic Ventures, Inc., Square Rig Photography, Eric V. Keibler and/or Ann Y. Keibler to use photographs of me and or my property and authorize him/(her/their and his/her/their assignees), licensees, legal representatives and transferees to use and publish (with or without my name, company name, or with a fictitious name) photographs, pictures, portraits or images herein described in any and all forms and media and in all manners including composite images or distorted representations, and the purposes of publicity, illustration, commercial art, advertising, publishing (including publishing in electronic form on CDs or internet websites), for any product or services, or other lawful uses as may be determined by the photographer or studio named here.

I further waive any and all rights to review or approve any uses of the images, any written copy or finished product. I am of full legal age or have the permission of a legal guardian and have read and fully understand the terms of this release.

Description of images: Images taken before, during or after the event, trip or course are covered by this form.

______Signature Date

______Print Name

I am the parent or legal guardian of the above mentioned minor and have the legal right and authority to execute the above release on behalf of the minor.

______(Parent/Guardian Signature)

______Print Name City of West University Place Parks and Recreation Department West University Place, Texas 77005

PLEASE PRINT

Name: ______

Address: ______

City: ______

Zip Code: ______

Waiver

We have asked to participate in the above-described activity of the City of West University Place, Texas ("City"). By signing below, we agree to the following on behalf of ourselves and all others claiming by, through or under us:

1. Rules. We agree to abide by the City's rules and policies for this activity.

2. Inspection and Acceptance. The City has allowed us to inspect the areas, facilities, conditions, vehicles and equipment of the activity. We accept all of them. We accept and assume all risks and hazards relating to participation in the activity. We have obtained insurance to cover claims mentioned below.

3. Release. With respect to any claims for injury to either of us (including any injury causing death) and any claims for loss of, or damage to, property, we agree to the following: (1) the City shall not be liable or responsible for any of these claims; and (2) we release the City from any responsibility or liability for these claims and agree not to sue the City on any of these claims. We understand that the word "claims" includes all of the following that have arisen, or may arise later, in connection with the activity, whether known or unknown: claims, demands, causes of action, losses, costs, liabilities and related expenses, including those involving the joint or sole negligence of the City, those involving the negligence of ourselves or others and those which arise otherwise. (The word "City", as used in this document, includes the City as an entity as well as its officers, agents, employees, receivers, representatives, contractors, sponsors, committees, organizers, volunteers and all others acting on its behalf.) We understand that our photo or likeness may be used in any promotional materials and/or publications that the City may deem fit.

4. Limitation of Liability. If, notwithstanding our intent, the release written above is not effective for any reason, we agree that the City's liability for any loss or damage relating to the activity shall be limited to the sum of $100 per occurrence. This limit applies to all losses or damages, irrespective of cause or origin, whether in tort, contract, strict liability or otherwise.

Agreed: Agreed: ADULT PARTICIPANT PARENT OR GUARDIAN

______Signature Signature

______Printed Name Printed Name

______Date Date Medical Statement ———————————— PARTICIPANT RECORD — CONFIDENTIAL INFORMATION ————————————— Please read carefully before signing.

This is a statement in which you are informed of some potential To scuba dive safely, you must not be extremely overweight or risks involved in scuba diving and of the conduct required of you out of condition. Diving can be strenuous under certain conditions. during the scuba training program. Your signature on this state- Your respiratory and circulatory systems must be in good health. All ment is required for you to participate in the scuba training program offered by: body air spaces must be normal and healthy. A person with heart trouble, a current cold or congestion, epilepsy, asthma, a severe (INSTRUCTOR) ______medical problem, or who is under the influence of alcohol or drugs and (FACILITY) ______should not dive. If taking medication, consult your doctor and the located in the city of ______Instructor before participation in this program. You will also need to and state of ______. learn from the Instructor the important safety rules regarding breathing and equalization while scuba diving. Improper use of Read and discuss this statement prior to signing it. You must complete this Medical Statement, which includes the medical-histo- scuba equipment can result in serious injury. You must be thor- ry section, to enroll in the scuba training program. If you are a oughly instructed in its use under direct supervision of a qualified minor, you must have this Statement signed by a parent. Instructor to use it safely. Diving is an exciting and demanding activity. When performed If you have any additional questions regarding this Medical correctly, applying correct techniques, it is very safe. When estab- lished safety procedures are not followed, however, there Statement or the Medical History section, review them with your are dangers. Instructor before signing. Medical History To the Participant: The purpose of this medical questionnaire is to find out if you should be examined by your doctor before participating in recreational diver training. A positive response to a question does not necessarily disqualify you from diving. A positive response means that there is a preex- isting condition that may affect your safety while diving and you must seek the advice of your physician. Please answer the following questions on your past or present medical history with a YES or NO. If you are not sure, answer YES. If any of these items apply to you, we must request that you consult with a physician prior to participating in scuba diving. Your Instructor will sup- ply you with a medical statement and guidelines for recreational scuba diver’s physical examination to take to your physician. ____ Could you be pregnant, or are you ____ Any form of lung disease? ____ Head injury with loss of conscious- attempting to become pregnant? ____ Pneumothorax (collapsed lung)? ness in the past five years? ____ Are you presently taking presecrip- ____ Other chest disease or ____ Recurrent back problems? tion medications? (with the excep- chest surgery? ____ Back or spinal surgery? tion of birth control or anti-malarial) ____ Behavioral health, mental or ____ Diabetes? ____ Are you over 45 years of age and can psychological problems problems answer YES to one or more of the ____ Back, arm or leg problems following (panic attack, fear of closed or surgery, injury or fracture? following? open spaces)? • currently smoke a pipe, cigars, ____ High blood pressure or take medica- ____ Epilepsy, seizures, convulsions or or cigarettes tion to control blood pressure? • have a high cholesterol level take medications to prevent them? ____ Heart disease? • have a family history of heart ____ Recurring migraine headaches or ____ Heart attack? take medications to prevent them? attacks or strokes ____ Angina, heart surgery or blood ____ Blackouts or fainting (full/partial loss • are currently receiving vessel surgery? of consciousness)? medical care ____ Sinus surgery? • high blood pressure ____ Frequent or severe suffering • diabetes mellitus, even if from motion sickness (seasick, ____ Ear disease or surgery, hearing loss controlled by diet alone carsick, etc.)? or problems with balance? ____ Recurrent ear problems? HAVE YOU EVER HAD OR DO ____ Dysentery or dehydration requiring YOU CURRENTLY HAVE… medical intervention? ____ Bleeding or other blood disorders? ____ Hernia? ____ Asthma, or wheezing with breathing, ____ Any dive accidents or decompression or wheezing with exercise? sickness? ____ Ulcers or ulcer surgery? ____ Frequent or severe attacks of ____ Inability to perform moderate exer- ____ A colostomy or ileostomy? hayfever or allergy? cise (example: walk 1.6 km/one mile ____ Recreational drug use or treatment ____ Frequent colds, sinusitis or within 12 mins.)? for, or alcoholism in the past bronchitis? five years? The information I have provided about my medical history 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 condition.

______SIGNATURE DATE

______SIGNATURES OF PARENTS OR GUARDIANS WHERE APPLICABLE DATE

Name ______Birth Date ______Age ______First Initial Last Mailing Address ______

______

City ______State/Province ______

Country ______Zip/Postal Code ______

Home Phone ( ______) Business Phone ______( )

Telex ______FAX ______

Name and address of your family or primary care physician:

Physician ______Clinic/Hospital ______

Address ______Phone ( ______)

Date of last physical examination ______

Name of examiner ______Clinic/Hospital ______

Address ______Phone ( ______)

Were you ever required to have a physical for diving? Yes No If so, when? ______

Physician This person is an applicant for training or is presently certified to engage in scuba (self contained underwater breathing apparatus) diving. Your opinion of the applicant’s medical fitness for scuba diving is requested. Please review Guidelines for Recreational Scuba Diver’s Physical Examination.

Physician’s Impression:

I find no medical conditions that I consider incompatible with diving.

I am unable to recommend this individual for diving.

Remarks ______

I have reviewed Guidelines for Recreational Scuba Diver’s Physical Examination.

______, M.D. Date ______Physician’s Signature

Physician ______Clinic/Hospital ______

Address ______Phone (______)