Scuba Diving Course Waiver and Liability Release Form
Please complete this waiver to participate in the scuba diving course. Your safety and understanding of the associated risks are important.
Full Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Emergency Contact Name
*
First Name
Last Name
Emergency Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Scuba Diving Experience
*
No previous experience
Beginner (completed introductory course)
Certified diver (e.g., Open Water, Advanced)
Other
Do you have any medical conditions or physical limitations that may affect your ability to safely participate in scuba diving?
*
No, I am fit to participate
Yes, I have a condition (please specify below)
If yes, please specify your condition(s):
Participant Signature
*
Submit Waiver
Submit Waiver
Should be Empty: