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Release and Waiver

 HELP-NET EXPEDITIONS

 

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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Last modified: March 14, 2010