RICHARD SALAS ASK PHOTOGRAPHY INC.
RELEASE OF LIABILITY, WAIVER OF CLAIMS, EXPRESS ASSUMPTION OF RISK AND INDEMNITY AGREEMENT Please read carefully. Fill out all the requested information, initial each paragraph and sign this document.
I ________________________________________________(Print Name), do hereby affirm that I am a certified scuba diver from the nationally recognized scuba diving agency ____________________________(Agency Name) and that I hold training to the level of ________________________________(Level of Training). I am aware of the required certification level and / or experience necessary and recommended to enroll in this diving trip and I stipulate that I meet those requirements for prior certification or equivalent experience. I have been a certified diver since ____________Date Certified) and I have been diving for ____________Years Diving) for an approximate total of ____________(Number of Dives) dives to a maximum depth of ___________(Maximum Depth) feet. I further state that I am of lawful age and legally competent to sign this liability release. I am voluntarily signing this document of my own free will.
____Initial I understand that the terms herein are contractual and not a mere recital, and that I have signed this document of my own free act. Further that I understand and agree that, in the event that one or more of the provisions of this agreement, for any reason, is held by a court of competent jurisdiction to be invalid or unenforceable in any respect, such invalidity, illegality or unenforceability shall not effect any other provision hereof, and this agreement shall be construed as if such invalid, illegal or unenforceable provision or provisions had never been contained herein.
____Initial I understand that there is risk associated with dive travel, including, but not limited to the possible loss of life or injury from traveling by airplane, vehicle, foot and by boat. I understand that there is risk of property damage, injury or loss of life as a result a dive boat accident while the boat is at port, traveling, at anchor, and while diving from the boat and from the dive skiffs. I also understand that there are other hazards associated with dive travel, including but not limited to earthquakes, diseases and other medical problems, robbery, acts of terrorism, assault and battery, food poisoning, impure water, temperature related illnesses and other problems. I understand that professional medical assistance may not be immediately available. I fully accept these risks. I understand that it is my responsibility to purchase my own personal Dive Accident Insurance and optional Travel Insurance and that similar policies are not provided to me as part of the charter.
____Initial I am aware of the inherent hazards and risks associated with skin and scuba diving. I fully understand that these risks can lead to severe injury and even death. I am voluntarily participating in these diving activities and accept all the inherent and associated risks. I understand that diving operations may be conducted at a site that is remote from a recompression chamber and competent medical assistance. Nevertheless, I choose to proceed even in the absence of a recompression chamber and competent medical assistance. Despite the potential hazards and dangers associated with the activity of diving, I wish to proceed and I freely accept and expressly assume all risk, dangers and hazards that may arise from diving activities which could result in property damage, personal injury and loss of life to me. I agree that I will be fully responsible for all costs associated with an emergency evacuation and treatment in a medical facility and / or recompression chamber.
____Initial I understand that there are also risks and hazards associated in diving with sharks, marine mammals, alligators, crocodiles, poisonous snakes, eels, fish and other marine organisms. I fully accept these risks and hazards, knowing that I could be injured or even killed. I also realize and accept the risk of Post Traumatic Stress Disorder in the event of a stressful situation resulting from my diving activities or observing a stressful situation whether in the water, on the boat or on land.
____Initial I understand that I will be responsible for my own diving safety. I will not hold Richard H Salas nor ASK Photography Inc. responsible or liable for any problem that may occur while diving or resulting from diving. I understand that I may be making deeper dives, diving inside or around wrecks and caves, diving in kelp, diving in currents and also making “blue water dives” where the bottom is very deep and far from land. I also understand that I may also be voluntarily diving inside a shark cage wearing a heavy weight harness (approximately 30-50 pounds) while using surface supplied air, with limited and restricted emergency access to the surface. I accept the risks and hazards associated with these types of dives.
____Initial In consideration of being allowed to participate in these skin and scuba diving activities, I hereby agree to waive and release any and all claims based upon negligence, active or passive with the exception of intentional, wanton or willful misconduct, that I may have in the future against ASK Photography Inc., Richard H Salas and his family, estate and heirs. I hereby agree to waive and release the above named from all liability or responsibility whatsoever for personal injury, property damage or wrongful death however caused, or arising out of, directly or indirectly, including, but not limited to, the negligence of the released parties, whether active or passive. CONTINUED ON PAGE 2 Page 1
CONTINUATION OF RELEASE OF LIABILITY, WAIVER OF CLAIMS, EXPRESS ASSUMPTION OF RISK AND INDEMNITY AGREEMENT: ASK PHOTOGRAPHY INC.
____Initial This document shall be binding upon me and my successors, heirs, executors, administrators, and assigns. I have read this agreement and fully understand the legal rights I am giving up by signing this document. I HAVE READ THIS AGREEMENT, I UNDERSTAND IT, I AGREE TO BE BOUND BY IT.
________________________________________________________________(Signature of Participant) ___________________________(Date)
________________________________________________________________________________________________(Permanent Mailing Address)
EMERGENCY CONTACT: _______________________________________________________(Name) ___________________________(Phone)
RELATIONSHIP TO DIVER: ___________________________________________________________
WITNESS NAME (Print)_____________________________________________________________
WITNESS SIGNATURE ______________________________________________________________ ______________________________(Date)
The above Waiver & Release document covers a variety of dive charters and related travel. I realize that no one likes to be hassled with these risk management documents, but they are necessary in today's society where we participate in activities such as diving (and skiing, hiking, snowmobiling, bungee-jumping, motorcycling, para-sailing, etc.) that can be inherently dangerous. This document affirms your clear understanding that diving and other activities you may choose to engage in on our trip have the potential to be dangerous including the possibility of death or serious injury. And you are agreeing to waive your right (and that of any heirs) to sue me or the charter operation in the event that you suffer a mishap.
If, for any reason, you do not feel that you fully understand the legal contract of release to which you are agreeing when you sign and execute the Waiver, then I strongly urge you to consult with your own attorney or legal advisor before signing it. You also may want to discuss this with any heirs as their rights to sue or make a claim are also being waived.
The document also clarifies my role as being limited to that of trip organizer on behalf of our group solely for the purpose of handling negotiation of fees, collecting such money from participants, and making payment to the charter operation. I am not acting in the role of diving instructor, guide, or any capacity for direct or indirect supervision of your diving activities, vessel operations, or any shore trips, etc. So you are expected to be fully capable of making decisions independently when it comes to what dives and other activities you choose to do and how you conduct them.
I need you print out the 2-page document, fill in all blanks completely, initial the space before each paragraph section, sign the last page and have it witnessed by an adult. Scan & E-mail or mail it to me at the address below. You have to execute this document to go on the trip and you can't make any changes. Thanks for understanding and cooperating
SCAN & E-MAIL TO: firstname.lastname@example.org
OR MAIL TO:
ASK Photography Inc,
P. O. Box 1118
Santa Barbara, California 93116