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STATEMENT OF RISKS AND LIABILITY
Please read carefully and fill in all blanks before signing.
This is a statement in which you are informed of the risks of skin and scuba diving. The statement also sets out the circumstances in which you participate in the diving programme at your own risk.
Your signature on this statement is required as proof that you have received and read this statement. It is important that you read the contents of this statement before signing it. If you do not understand anything contained in this statement, then please discuss it with your instructor. If you are a minor, a parent or guardian must also sign this form.
WARNING
Skin and scuba diving have inherent risks, which may result in serious injury or death.
Diving with compressed air involves certain inherent risks; decompression sickness, embolism or other hyperbaric injury can occur that require treatment in a recompression chamber. Open water diving trips, which are necessary for training and for certification, may be conducted at a site that is remote, either by time or distance or both, from such a recompression chamber. Skin and scuba diving are physically strenuous activities and you will be exerting yourself during this diving programme. You must advise truthfully and fully inform the dive professionals and the facility through which this programme is offered of your medical history.
EXCLUSION OF LIABILITY
I understand and agree that neither the dive professionals conducting this programme, Kostas Sgourakis, nor the facility through which this programme is conducted, Mykonos Diving Center / Dive Adventures, nor PADI International Ltd., nor PADI Americas, Inc., nor their affiliate or subsidiary corporations, nor any of their respective employees, officers, agents or assigns (hereinafter referred to as “Released Parties”) accept any responsibility for any death, injury or other loss suffered or caused by me or resulting from my own conduct or any matter or condition under my control that amounts to my own contributory negligence.
In the absence of any negligence or other breach of duty by the dive professionals conducting this programme, Kostas Sgourakis, the facility through which this programme is offered, Mykonos Diving Centre / Dive Adventures, PADI International Ltd., PADI Americas, Inc., and all released entities and released parties as defined above, my participation in this diving programme is entirely at my own risk.
I acknowledge receipt of this Statement and have read all of the terms before signing this Statement.
Participant Name
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Year Qualified
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By
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For Headquarters Use:
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Program
1TD boat
1TD beach
2TD boat
2TD beach
5TD
10TD
Scuba Review
SNA Boat
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DP
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EQUIPMENT
MASK & SNORKEL
SCOUT
SPECTRA
F II
FI
PRESCR
CRESSI
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FINS
32-34
36-37
38-39
40-41
42-43
44-45
46-47
3XS
2XS
XS-S
S
M-L
XL
2XL
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WETSUIT
Kids S
Kids M
Kids L
0
1
2
3
4
5
6
7
8
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WEIGHTBELT
2
4
6
8
10
12
14
16
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BCD JACKET
XXXS
XXS
XS
S
M
L
XL
XXL
XXXL
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REG/OCTO/CONS/LPI
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TANK
3L.
6L.
10 L.
12 L.
15 L.
18L.
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OTHER:
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Extras
CAMERA
COMPUTER
ENRICHED AIR
TANK 15L-18L
SD CARD
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PLEASE CHECK YOUR GEAR ! ! !
* IT IS YOUR RESPONSIBILITY TO MAKE SURE YOUR GEAR IS IN GOOD WORKING ORDER *
RENTER AGREES TO PAY FULL VALUE OF ITEMS, PLUS ANY COSTS INCURRED IN COLLECTION, IN CASE OF LOSS OR FULL REPAIR COST IN CASE OF DAMAGE. RENTER ALSO AGREES TO PAY THE REQUIRED CLEANING FEE IF DIVING GEAR IS BROUGHT BACK IN UNSATISFACTORY CONDITION.
“I HAVE EXAMINED THE EQUIPMENT AND FIND IT ALL IN GOOD ORDER AND CERTIFY THAT I AM PROPERLY TRAINED IN ITS USE.
I FURTHER HOLD HARMLESS THE STORE AND ITS AGENTS FROM ANY ACCIDENT OCCURRING DURING THE USE OF SAID EQUIPMENT”.
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PERSONAL INFO
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