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RELEASE AND WAIVER OF
LIABILITY AND ASSUMPTION OF RISK
Please read carefully, fill in the blanks and
initial each paragraph before signing.
In consideration of being permitted to travel
with Help-Net Expeditions, David Fellows. The undersigned agrees
to and hereby contracts to the following terms:
_____ I, hereby affirm that I am aware of and
hereby acknowledge the inherent hazards of skin diving, scuba
diving and other water sports.
_____ I, acknowledge that I am a certified
scuba diver trained in safe diving practices and have practiced
my diving skills within the last year.
_____ I, understand this Release and Waiver of
Liability and Assumption of Risk hereby encompasses and applies
to all diving activities and any and all other activities which I
choose to engage in.
_____ I, understand and agree that this Release
applies to Help-Net Expeditions, David Fellows, their employees,
agents and assigns.
_____ Further, I understand that scuba diving
involves certain risks and dangers associated therewith,
including but not limited to risks associated with equipment
failure, perils of the sea, acts of fellow divers, decompression
sickness, embolism or other hyperbolic injuries that require
treatment in a recompression chamber. Despite the possible lack
of a recompression chamber and/or limited medical facilities, at
the dive site and in the event of illness or injury, appropriate
medical care must be summoned by radio. Treatment may be delayed
until I can be transported to a proper medical care facility, I
still choose to engage in scuba diving and/or other activities.
_____ I, understand and agree that neither Help-Net
Expeditions, David Fellows, nor any of their respective employees,
agents or assigns have made representation to me, implied or
otherwise, that they can or will perform safe rescues or render
first aid. In the event I show signs of distress or call for aid;
I would like assistance and will not hold anyone responsible for
their actions in attempting the performance of a rescue or first
aid. I will not hold Help-Net Expeditions, David Fellows, their
employees, agents or assigns liable or responsible in any way for
any injury, death, or damages to me or my family, heirs, or
assigns that may occur as a result of my participation in diving
activities or as a result of the negligence of any party.
_____ I, authorize treatment by a qualified and
licensed physician (or someone under the direction of same) in
the event of a medical emergency which, in the opinion of the
attending physician, may endanger my life, cause disfigurement,
physical impairment or undue discomfort if delayed.
_____ As a condition of being allowed on the
expedition I hereby personally assume all risk in connection with
diving, and any harm, injury or damage that may befall me while I
am on the expedition, including all risks whether foreseen or
unforeseen.
_____ I, further release and exempt said
activities and Help-Net Expeditions, David Fellows, their
employees, agents and assigns from any claim or lawsuit by me, my
family, estate heirs or assigns, arising out of my activities and
participation in any and all activities while on expeditions
previously described.
_____ I, acknowledge that I am physically fit
to scuba dive and skin dive. I also understand that skin diving
and scuba diving cause physical strain or exertion not
necessarily experienced in non-diving situations. I assume all
risks for, and will not hold the released parties responsible for
any injuries including injuries due to heart attack, panic,
hyperventilation or other injuries caused by physical strain and
exertion.
_____ I, expressly acknowledge and agree that
any and all activities I may participate in while on the above
expedition involve risk of serious injury and/or death and/or
property damage. I expressly agree that this Release and Waiver
of Liability and Assumption of Risk is intended to be as broad
and inclusive as permitted by law, that if any portion thereof is
held invalid, it is agreed that the balance shall,
notwithstanding, continue in full legal force and effect.
_____ I, further state that I am of lawful age
and legally competent to sign this Release or that I have
acquired the written consent of my parent or guardian.
_____ I, hereby state and agree that this
Release will be effective and valid for all activities on the
above-described expedition for a period of one year from the
initial date on which I execute this Release.
_____ I, understand that the terms herein are
contractual and not a mere recital, and that I have signed this
document of my own free will and that no oral representations,
statements or inducements apart from the foregoing written
agreement have been made.
Divers Alert Network: DAN members are eligible
for affordable dive accident insurance. DAN provides vital
services no diver should be without; Help in Diving Emergencies,
24-hour hotline, Alert Magazine, DAN's Medical Info line,
TravelAssist Air Evacuation Benefits, and many more. For more information 919.684.2948
Are you a DAN member: if yes Member Number
____________________.
It is the intention of (print
your name)_____________________________________________
by this document to exempt and release Help-Net Expeditions,
David Fellows, their agents, employees, and assigns, from all
liability or responsibility whatsoever for personal injury,
property damage or wrongful however caused, including, but
limited to, the negligence of the released parties, whether
passive or active.
I have fully informed myself of the contents of
this Release and Waiver of Liability and Assumption of Risk by
reading it before I signed it on behalf of my heirs and myself. I
further understand and agree that this release is effective and
valid for a period of one year from the date on which I execute
this release.
Your Signature___________________________________________
Date_________________
Certification Level ______________Certification
Agency _________________ Certification Number____________________
Signature of Parent or Guardian (Where
applicable)_________________________________
Date _________
Please Print Name
___________________________________________________________
Address
___________________________________________________________________
City, State, Zip
______________________________________________________________
Phone Number ________________________ Emergency
Contact ____________________________ Relationship ____________
Please list medical allergies, medicine being
taken or other conditions a physician or staff member should be
aware of (if none, please write NONE or if more room is needed
please use the back):
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