Page 1 of 7 Choose your session: Marine Quest □ Oceans 17 (1) – Starts June 21 □ Oceans 17 (2) – Starts July 12 Forms Packet For: _____________ _______________ Full Name Instructions: Important Notes: ● For instructions and additional information, visit ● This packet should be submitted http://www.aquaticsafaris.com/mqforms/ WITH the regular Oceans 17 packet ● Use Acrobat Reader to fill in forms before printing for those participating in the Open Water Diver course as well. ● Note that some forms appear to be similar to the other forms packet. Since you will be taking two classes with ● Electronic signatures will NOT be us (Open Water Diver and Advanced Open Water accepted Diver), we need all of the forms filled out completely. ● You may scan signed forms with ● Please carefully read, complete, and sign each page. your smart phone using a free app Signature lines are marked with green or orange arrows such as Tiny Scanner by Appxy for the student or parent to sign, respectively. ● Please ensure that scanned forms ● Dates are the international DD/MM/YYYY format are legible, and pages are in order in a single PDF before sending ● Answer “YES” or “NO” to each question on the Medica l Statement (page 4). Any “YES” answer will require a physician's clearance to dive. See our website (above) to obtain the proper forms. ● Once all forms are completed and signed by both the student and parent/guardian, and physician's clearance has been obtained if necessary, scan and e-mail forms to: [email protected] If you are unable to submit completed forms by May 1st, be sure to let us know! This packet must be completed and turned in to Aquatic Safaris no later than a week before the start of your program. Please confirm receipt and completeness prior to that date. Failure to do so may impact your ability to participate in the diving components of your Marine Quest program. Page 2 of 7 Non-Agency Disclosure and Acknowledgment Agreement In European Union and European Free Trade Association countries use alternative form. Please read carefully and ll in all blanks before signing. I understand and agree that PADI Members (“Members”), including Aquatic Safaris Scuba Center, Inc. and/or any individual PADI Instructors and Divemasters associated with the program in which I am participat- ing, are licensed to use various PADI Trademarks and to conduct PADI training, but are not agents, employees or franchisees of PADI Americas, Inc, or its parent, subsidiary and af liated corporations (“PADI”). I further understand that Member business activities are independent, and are neither owned nor operated by PADI, and that while PADI establishes the standards for PADI diver train- ing programs, it is not responsible for, nor does it have the right to control, the operation of the Members’ business activities and the day-to day conduct of PADI programs and supervision of divers by the Members or their associated sta. 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 es- tate shall seek to hold PADI liable for the actions, inactions or negligence of Aquatic Safaris Scuba Center, Inc. and/or the instructors and divemasters associated with the activity. Liability Release and Assumption of Risk Agreement In European Union and European Free Trade Association countries use alternative form. Please read carefully and ll in all blanks before signing. I, _________________Participant_____ Name____________________ , hereby I also understand that skin diving and scuba diving are physically af rm that I am aware that skin and scuba diving have inherent risks strenuous activities and that I will be exerting myself during this which may result in serious injury or death. program, and that if I am injured as a result of heart attack, panic, hyperventilation, drowning or any other cause, that I expressly as- I understand that diving with compressed air involves certain inherent sume the risk of said injuries and that I will not hold the Released risks; including but not limited to decompression sickness, embolism Parties responsible for the same. or other hyperbaric/air expansion injury that require treatment in a recompression chamber. I further understand that the open water I further state that I am of lawful age and legally competent to sign diving trips which are necessary for training and for certi cation may this liability release, or that I have acquired the written consent of be conducted at a site that is remote, either by time or distance or my parent or guardian. I understand the terms herein are contractual both, from such a recompression chamber. I still choose to proceed and not a mere recital, and that I have signed this Agreement of my with such instructional dives in spite of the possible absence of a own free act and with the knowledge that I hereby agree to waive recompression chamber in proximity to the dive site. my legal rights. I further agree that if any provision of this Agree- ment is found to be unenforceable or invalid, that provision shall be I understand and agree that neither my instructor(s), the severed from this Agreement. The remainder of this Agreement will Professional Staff of Aquatic Safaris Scuba Center, Inc., the facility through then be construed as though the unenforceable provision had never which I receive my instruction, Aquatic Safaris Scuba Center, Inc., been contained herein. nor PADI Americas, Inc., nor its af liate and subsidiary corporations, nor any of their respective employees, of cers, agents, contractors I understand and agree that I am not only giving up my right to sue or assigns (hereinafter referred to as “Released Parties”) may be the Released Parties but also any rights my heirs, assigns, or bene - held liable or responsible in any way for any injury, death or other ciaries may have to sue the Released Parties resulting from my death. damages to me, my family, estate, heirs or assigns that may occur I further represent I have the authority to do so and that my heirs, as a result of my participation in this diving program or as a result of assigns, or bene ciaries will be estopped from claiming otherwise the negligence of any party, including the Released Parties, whether because of my representations to the Released Parties. passive or active. I, ___________________________________________Participant Name _, In consideration of being allowed to participate in this course (and BY THIS INSTRUMENT AGREE TO EXEMPT AND RELEASE MY optional Adventure Dive), hereinafter referred to as “program,” I ,SROTCURTSNI ehT lanoisseforP ffatS fo citauqA sirafaS abucS ,retneC ,.cnI hereby personally assume all risks of this program, whether foreseen EHT YTILICAF HGUORHT HCIHW I EVIECER YM ,NOITCURTSNI or unforeseen, that may befall me while I am a participant in this Aquatic Safaris Scuba Center, Inc., AND program including, but not limited to, the academics, con ned water PADI AMERICAS, INC., AND ALL RELATED ENTITIES AS DEFINED and/or open water activities. ABOVE, FROM ALL LIABILITY OR RESPONSIBILITY WHATSOEVER FOR PERSONAL INJURY, PROPERTY DAMAGE OR WRONGFUL DEATH I further release, exempt and hold harmless said program and Re- HOWEVER CAUSED, INCLUDING, BUT NOT LIMITED TO, THE NEGLI- leased Parties from any claim or lawsuit by me, my family, estate, GENCE OF THE RELEASED PARTIES, WHETHER PASSIVE OR ACTIVE. heirs or assigns, arising out of my enrollment and participation in this program including both claims arising during the program or after I receive my certi cation. I HAVE FULLY INFORMED MYSELF AND MY HEIRS OF THE CONTENTS OF THIS NON-AGENCY DISCLOSURE AND ACKNOWLDGE- MENT AGREEMENT AND LIABILITY RELEASE AND ASSUMPTION OF RISK AGREEMENT BY READING BOTH BEFORE SIGNING BELOW ON BEHALF OF MYSELF AND MY HEIRS. _________________________________________________________________________________________________________________ __________________________________ Participant’s Signature Date (Day / Month / Year) _________________________________________________________________________________________________________________ __________________________________ Signature of Parent or Guardian (where applicable) Date (Day / Month / Year) Product No. 10072 (Rev. 06/15) Version 4.03 No electronic signatures, please! © PADI 2015 Page 3 of 7 Standard Safe Diving Practices Statement of Understanding Please read carefully before signing. This is a statement in which you are informed of the established safe diving practices for skin and scuba diving. These practices have been compiled for your review and acknowledgement and are intended to increase your comfort and safety in diving. Your signature on this statement is required as proof that you are aware of these safe diving practi- ces. Read and discuss the statement prior to signing it. If you are a minor, this form must also be signed by a parent or guardian. (Print Name) I, ___________________________________________________, understand that as a diver I should: 1. them in controlled conditions after a period of diving inactivity, and refer to my course materials to stay current and refresh myself on important information. 2. Be familiar with my dive sites. If not, obtain a formal diving orientation fr om a knowledgeable, local source. If diving conditions are worse than those in which I am experienced, postpone diving or select an alternate site with better conditions. Engage only in diving activities consistent with my training and experience. Do not engage in cave or 3. Use complete, well-maintained, r pressure gauge and alternate air source and dive planning/monitoring device (dive computer, RDP/dive tables—whi - 4. Listen car - cognize that additional training is recommended for participation in specialty diving activities, in other geographic areas and after periods of inactivity that exceed six months. 5. Adhere to the buddy system throughout every dive. Plan dives – including communications, procedures for reuniting in case of separation and emergency procedures – with my buddy.