Release of Liability/Assumption of Risk/Non-agency Acknowledgement Form: TRAVEL AND EXCURSIONS
Please read carefully before signing.
Non-Agency Disclosure and Acknowledgment Agreement
I understand and agree that PADI Members (“Members”), including SCUBA JUNKIE PENIDA #26943 and/or any individual PADI Instructors and Divemasters associated with the program in which I am participating, are licensed to use various PADI Trademarks and to conduct PADI training, but are not agents, employees or franchisees of PADI Americas, Inc, or its parent, subsidiary and affiliated corporations (“PADI”). I further understand that Member business activities are independent, and are neither owned nor operated by PADI, and that while PADI establishes the standards for PADI diver training programs, it is not responsible for, nor does it have the right to control, the operation of the Members’ business activities and the day-to-day conduct of PADI programs and supervision of divers by the Members or their associated staff. I further understand and agree on behalf of myself, my heirs and my estate that in the event of an injury or death during this activity, neither I nor my estate shall seek to hold PADI liable for the actions, inactions or negligence of SCUBA JUNKIE PENIDA #26943 and/or the instructors and divemasters associated with the activity.
Liability Release and Assumption of Risk Agreement
I, hereby affirm I am voluntarily engaging in the recreational activities planned for my trip to Nusa Penida & surrounding islands, which activities may include, but are not limited to, scuba diving, snorkelling and boating. If I engage in scuba diving, I affirm that I am a certified diver or a student diver under the control and supervision of a certified scuba instructor, and that I am aware that skin and scuba diving have inherent risks which may result in serious injury or death. I certify that I am fully aware of and expressly assume all risks involved in scuba diving, snorkelling, boating and other activities in which I choose to participate. I understand and agree that neither SCUBA JUNKIE PENIDA #26943, nor PADI Americas, Inc., nor its affiliate or subsidiary corporations, nor any of their respective employees, officers, agents, contractors or assigns (hereinafter referred to as “Released Parties,”) may be held liable or responsible in any way for any occurrence on this trip which may result in personal injury, property damage or wrongful death or other damages to me, my family, estate, heirs or assigns that may occur as a result of my participation in this trip or as a result of the negligence of any party, including the Released Parties, whether passive or active.
I further state that I am of lawful age and legally competent to sign this Liability Release Agreement, or that I have obtained the written consent of my parent or guardian.I understand the terms herein are contractual and not a mere recital, and that I have signed this Agreement of my own free act and with the knowledge that I hereby agree to waive my legal rights. I further agree that if any provision of this agreement is found to be unenforceable or invalid, that provision shall be severed from this agreement. The remainder of this agreement will then be construed as though the unenforceable provision had never been contained herein.I understand and agree that I am not only giving up my right to sue the Released Parties but also any rights my heirs, assigns, or beneficiaries may have to sue the Released Parties resulting from my death. I further represent I have the authority to do so and that my heirs, assigns, and beneficiaries will be estopped from claiming otherwise because of my representations to the Released Parties.
I, by this instrument, agree to exempt and release all the above listed entities and/or individuals, whether specifically named or not, from all liability and responsibility for personal injury, property damage or wrongful death, however caused, including, but not limited to, product liability or the negligence of the released parties, whether passive or active.
I have fully informed myself and my heirs of the contents of this non-agency disclosure and acknowledgement agreement and liability release and assumption of risk agreement by reading both before signing below on behalf of myself and my heirs.
PRODUCT NO. 10079 (Rev. 12/12) Version 5.01 © PADI 2012
