Scuba Diving is an exciting and demanding activity. To scuba dive you must not be extremely overweight or out of condition. Diving can be strenuous under certain conditions. Your respiratory and circulatory systems must be in good health. All body air spaces must be normal and healthy. A person without hearth trouble, a current cold or congestion, epilepsy, asthma, a severe medical problem, or who is under the influence of alcohol or drugs, should not dive. If taking medication, consult your doctor before participating in this program.
The purpose of the Medical Questionnaire is to find out if you should be examined by a physician before participating in recreational scuba diving. A positive response to a question does not necessarily disqualify you from diving. A positive response means there is a preexisting condition that may affect your safety while diving and you must seek the advice of a physician.
Please answer the following questions on your past and present medical history with a YES or NO. If you are not sure, answer YES. If any of these items apply to you, we must request that you consult with a physician prior to participating in scuba diving. Your Dive professional will supply you with a SSI Medical Statement and Guidelines for Recreational Scuba Divers Physical Examination to take to a physician.
Scuba diving is an adventure activity that requires the use of specialized life support equipment in an underwater environment where humans could not otherwise exist. As with other adventure activities, scuba diving has elements of risk that cannot be totally eliminated regardless of the amount of training, care, caution or expertise. SSI believes these risks may be reduced through the SSI Diver Diamond - development of proper Knowledge, Skills, Equipment and Experience. Ultimately it is up to each individual diver to assume the inherent risk associated with scuba diving and each diver’s responsibility to minimize the risk through exercising good judgment, common sense, respect and personal awareness during all diving activities. SSI has developed a Responsible Diver Code to remind divers of your responsibilities for each dive.
As a Responsible Diver - I pledge to:
Rich Coast Diving hosts Activities, including but not limited to snorkeling, freediving, breath-hold diving, scuba diving, technical diving, dive instruction, aquatic life interactions, land and underwater exploration, travel (in air, on land and over water), boating, fishing, lodging, food, beverages and all related activities (herein referred to as “Activities”). These Activities are inherently dangerous and may result in property loss, illness, injury, and death. In consideration of being allowed to participate in the Activities, I HEREBY AGREE TO BE LEGALLY BOUND BY THE TERMS AND CONDITIONS OF THIS ASSUMPTION OF RISK, LIABILITY RELEASE & HOLD HARMLESS AGREEMENT (herein referred to as “Agreement”).
Agreement Parties: I, on behalf of MYSELF, MY FAMILY, HEIRS, ASSIGNS, REPRESENTATIVES & ALL WHO MAY HAVE A CLAIM ON MY BEHALF (hereafter referred to as “me”, “my”, “I” or “Participant”), voluntarily enter into this Agreement with the aforementioned host, including but not limited to their owners, officers, directors, sponsors, agents, insurers, employees, captains, crewmembers, dive professionals, volunteers, boats (whether owned, operated, leased, or chartered), and all other persons and businesses associated with the Activities, whether specifically named or not (hereafter referred to as “Released Parties”).
Participant’s Responsibilities & Assumption of Risks: I understand there are inherent risks of property loss, illness, injury, and death associated with the Activities. I will follow safe practices, maintain awareness and use good judgment set forth in the applicable SSI Responsible Code to reduce the risks, however I know the risk of property loss, illness, injury and death cannot be eliminated. I hereby agree to be solely responsible for my health, safety, and actions. If I choose to scuba dive, I hereby affirm that I am a certified and competent diver or a student under the supervision of a certified scuba instructor. I am solely responsible to verify the function and adequacy of the equipment I use prior to each dive and to monitor my gas supply throughout my dives. I will plan and conduct all dives within my training and ability and return to the dive boat with a minimum of 500psi cylinder pressure. In the event I choose to dive without a dive partner or continue my dive in the absence of a dive partner, I understand and accept the increased risks of solo diving. I understand the Activities will expose me to inherent dangers including but not limited to: panic, drowning, decompression illness, overexpansion injuries, pressure related injuries, breathing gas toxicities, equipment failure, dangerous acts of others, infections, illnesses, allergic reactions, communicable illnesses and diseases, marine life bites and stings, dangerous environmental conditions, and risks associated with boating Activities, including but not limited to transits, boarding, departing, lodging, transfers, entering and exiting the water, that expose me to inherent dangers including but not limited to unexpected movements, slipping, tripping, falling, dangerous environmental conditions, fire, equipment failure, capsize, sinking, grounding, abandonment, collision, dangerous acts of others, being hit by a boat, hazards of the sea.
I UNDERSTAND THERE ARE RISKS OF PROPERTY LOSS, ILLNESS, INJURY AND DEATH EVEN WHEN ALL SAFETY MEASURES ARE IN PLACE AND UTILIZED. DESPITE THE RISK OF PROPERTY LOSS, ILLNESS, INJURY AND DEATH, I VOLUNTARILY CHOOSE TO PARTICIPATE IN THE ACTIVITIES AND ASSUME ALL RISKS ASSOCIATED WITH THE ACTIVITIES, WHETHER FORESEEN OR UNFORESEEN, AND WHETHER CREATED OR NOT BY THE RELEASED PARTIES.
Participant’s Condition & Emergency Awareness: I will participate in the Activities within my certification level, experience, skill and abilities. My participation in the Activities is voluntary and if I do not feel well, willing, capable and competent to participate, or if I become aware of an unsafe condition, I will take appropriate action for my safety and/or refrain from participation. I hereby affirm I am physically, medically and mentally fit to participate in the Activities. I will not hold the Released Parties responsible for any condition that results in illness, injury or death to me. I will not possess or consume illegal drugs or medications contraindicated for the Activities. I will not participate in the Activities while under the influence of alcohol or drugs (other than medications prescribed or authorized to me by a physician). I understand the Activities will be conducted at remote locations delaying emergency response, medical care and hyperbaric care. I understand that diving with compressed gases involves inherent risks, including but not limited to, over expansion injuries, decompression injuries, embolism and drowning. Diving injuries may require treatment in a hyperbaric chamber. I understand that these Activities may be conducted at a site that is remote, by time and distance, from a hyperbaric chamber and medical facilities. Despite the inherent risks, I expressly choose to proceed with the Activities in the absence of a nearby hyperbaric chamber and medical facility.
I EXPRESSLY ASSUME THESE RISKS AND HEREBY RELEASE THE RELEASED PARTIES FOR FAILURE TO RESCUE OR PROVIDE PROPER EMERGENCY RESPONSE OR MEDICAL CARE. I AUTHORIZE THE RELEASED PARTIES TO PROVIDE FIRST AID AND MEDICAL CARE TO ME IF I BECOME ILL OR INJURED. I AGREE TO BE SOLELY RESPONSIBLE FOR AND PAY ALL EXPENSES ASSOCIATED WITH ANY EMERGENCY RESPONSE AND MEDICAL CARE PROVIDED TO ME, INCLUDING BUT NOT LIMITED TO EMERGENCY OXYGEN, FIRST AID SUPPLIES, EMERGENCY RESPONSE, TRANSPORTATION, FOOD, LODGING, SPECIAL NEEDS, HYPERBARIC TREATMENT AND/OR MEDICAL CARE PRIVIDED BY THE RELEASED PARTIES. I UNDERSTAND THE IMPORTANCE OF, AND MY RESPONSIBILITY TO HAVE, PERSONAL INSURANCE THAT SPECIFICALLY COVERS DIVE AND TRAVEL RELEATED EMERGENCIES AND MEDICAL CARE.
Release of Liability: In consideration of being allowed to participate in the Activities, I HEREBY AGREE TO FOREVER RELEASE THE RELEASED PARTIES FROM ALL LIABILITY ARISING AS A RESULT OF MY PROPERTY LOSS OR DAMAGE, ILLNESS, INJURY AND OR DEATH DUE TO ANY ACT OR FAILURE TO ACT, INCLUDING BUT NOT LIMITED TO NEGLIGENCE OF ANYONE, INCLUDING NEGLIGENCE BY THE RELEASED PARTIES. I SHALL NOT HOLD THE RELEASED PARTIES RESPONSIBLE OR LIABLE FOR DEFECTIVE PRODUCTS OR THE ACTS OF THIRD PARTIES, VENDORS, SUPPLIERS OR CONTRACTORS. I UNDERSTAND THIS IS A COMPLETE AND UNCONDITIONAL RELEASE OF ALL LIABILITY OF THE RELEASED PARTIES TO THE GREATEST EXTENT ALLOWED BY LAW.
