Scuba Diving Liability Waiver Form

Participant Information

Full Name Date of Birth Phone Number Email Address Emergency Contact Name & Phone

Medical & Certification Information

Diver Certification Level Certifying Agency Certification Number Medical Conditions / Allergies

Acknowledgement & Release

I acknowledge and accept the inherent risks and dangers associated with scuba diving. I confirm that I am physically and mentally fit to participate in scuba diving activities and will comply with all rules and instructions.

I have read and understood the above information.

Signature Date