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SDI Recreational Course Packet

This packet must be completed for each SDI Course enrolled in at Nautilus Aquatics. 

CONTINUING WAIVER & RELEASE OF LIABILITY, ASSUMPTION OF RISK & INDEMNITY, AND EMERGENCY CARE PERMISSION

PLEASE READ CAREFULLY BEFORE SIGNING BECAUSE THIS IS A CONTINUING RELEASE OF LIABILITY AND WAIVER OF CERTAIN LEGAL RIGHTS. IT ALSO GRANTS CONTINUING PERMISSION FOR EMERGENCY CARE.

In consideration of permitting me, (participant), to enroll in a swim, snorkeling, or scuba diving instructional course and/or participate in Swimming, Snorkeling, Scuba Diving, Swim Parties, Physical Activities, and Related Operations (hereafter known as “Water Activities”) conducted by Diventures Holdings, LLC or any Diventures Subsidiaries (as defined below), beginning on April 20, 2024 I agree for myself, my personal representatives, heirs and next of kin:

I hereby acknowledge that Water Activities are potentially dangerous activities and involve the inherent risk of serious injury (including paralysis), death and/or property damage both in and under the water as well as on the pool deck itself.

I hereby release, waive, discharge and agree not to sue Diventures Holdings, LLC; its subsidiaries Diventures, LLC, Diventures Iowa, LLC, Diventures Springfield, LLC, Diventures Madison, LLC, Diventures Columbia, LLC, Diventures Atlanta, LLC, Diventures Lexington, LLC, Diventures Kansas City, LLC, Diventures Lincoln, LLC, Diventures Battle Creek, LLC, Diventures Arizona, LLC, Diventures Marietta, LLC, Diventures Memphis, LLC, Diventures Little Rock, LLC, and Diventures Virginia, LLC (collectively, “Diventures Subsidiaries”) and their respective facilities, staff, officers, instructors, agents or employees (collectively, the “Releasees”) from all liability to myself, my minor child(ren), my personal representatives, signs, heirs and next of kin for any and all loss or damage and any claim or demands therefore on account of injury to my person or property or resulting in my death, now and forever, arising out of or related to participation and/or instruction in said course, activities or any other related Water Activities that may occur.

I hereby assume full responsibility for any risk of bodily injury, death or property damage, now and forever, arising out of or related to participation and/or instruction in said course, Water Activities, or any other swimming/snorkeling operations conducted by Diventures Holdings, LLC or any Diventures Subsidiaries.

I hereby acknowledge that this Waiver and Release of Liability is intended to be as broad and inclusive as permitted by the laws of the state in which the activities are conducted, and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect.

I hereby assume full responsibility for determining the need for and providing an interpreter for a language other than English within the facility.

I acknowledge that it is my responsibility to provide for my own and/or my child(ren)’s own accident and health coverage while participating in Water Activities.

In the event I cannot be reached and/or am incapacitated or otherwise able to give consent, I give permission for emergency medical, surgical and hospital treatment and procedures to be performed by a licensed physician or hospital, when deemed immediately necessary to safeguard my/my child(ren)’s health. I relieve Releasees of any and all responsibility for action(s) taken by the doctor(s), hospitals, or other medical care providers in the treatment and attendance of me or my child.

I agree that this waiver, release of liability, assumption of the risk, and consent for emergency medical, surgical and hospital treatment shall be continuing and effective for all Water Activities conducted by or on behalf of the above named Releasees for a period of time beginning with the execution of this document and terminating at 11:59 P.M., CST, on the 365th day after the date on which this document was signed.

I Agree

Staff Release

By signing this document, I am in full understanding of what constitutes “Staff of Nautilus Aquatics” or “All Staff of Nautilus Aquatics” as referenced in the liability waivers below. I further understand that this list is subject to change at any time to encompass any and all individuals who may be present during SCUBA training or any associated activity. It is the sole decision of the owners of Diventures Virginia, LLC, dba Nautilus Aquatics, henceforth known as Nautilus Aquatics, to determine what individuals will be considered part of the staff at any time. By signing this document, I acknowledge that I am in full understanding that all liability is being waived for all associates of Nautilus Aquatics, to include any facility or other business or vessel. I further understand that Nautilus Aquatics will not be held responsible for any incident or misadventure that may occur before, during or after any activity. By signing this document, I am agreeing that none of my associates or family members can hold Nautilus Aquatics or any of their associates responsible, or liable, for any incident or misadventure before, during, or after any activity. I understand that all of these conditions apply to any minor (individual under the age of 18 years) that I may be signing for as well, and will accept full responsibility for their actions at all times. 

I Agree

SDI GENERAL LIABILITY RELEASE AND EXPRESS ASSUMPTION OF RISK

Please read carefully, fill in all blanks and initial each paragraph before signing at bottom

FOR THE TRAINING PROGRAM INDICATED BELOW UNDER SANCTION THROUGH SDI. 

Please read carefully. If any questions arise, ask your instructor or dive facility before signing. 

I, hereby affirm that I have been advised and thoroughly informed of the inherent hazards of scuba diving activities

Further, I understand that diving with compressed air or oxygen enriched air (nitrox) involves certain inherent risks including decompression sickness, embolism, oxygen toxicity, inert gas narcosis, marine life injuries or other barotrauma/hyperbaric injuries can occur that require treatment in a recompression chamber. I further understand that the open water diving trips, which are necessary for training and certi cation, may be conducted at a site that is remote, either by time of distance or both, from such a recompression chamber. I still choose to proceed with such instructional dives in spite of the possible absence of a recompression chamber in proximity to the dive site.


I understand and agree that neither my Instructor(s) All Staff of Nautilus Aquatics, the facility through which I received my Instruction, NAUTILUS AQUATICS, International Training and Scuba Diving International, nor the officers, directors, shareholders, affliated companies, employees, agents, or assigns of the above listed entities and/or individuals, nor the authors of any materials including texts and tables expressly used for training and certification (hereinafter referred to as “Released Parties”) may be held liable or responsible in any way for any injury, death, or other damages to me or my family, heirs, or assigns that may occur as a result of my participation in this diving class or as a result of the negligence of any party, including the Released Parties, whether passive or active.


In consideration of being allowed to enroll in this course, I hereby personally assume all risks in connection with said course, for any harm, injury, or damage that may befall me while I am enrolled as a student of this course, including all risks connected therewith, whether foreseen or unforeseen.


I further agree to save, defend, indemnify, and hold harmless said course and Released Parties from any claim or lawsuit by me, anyone purporting to act on my behalf, my family, estate, heirs or assigns, arising directly or indirectly out of my enrollment and participation in this course including both claims arising during the course or after I receive my certification even if such claims may be groundless, false or fraudulent.


I also understand that diving activities are physically strenuous and that I will be exerting myself during this diving course, and that if I am injured as a result of heart attack, panic, hyperventilation, oxygen toxicity, inert gas narcosis, drowning, etc. that I expressly assume the risk of said injuries and that I will not hold the above listed individuals or companies responsible for the same, and I agree to defend, indemnify, and hold harmless said course and Released Parties for any such injuries incurred by me.


I understand that these activities may place me deeper than I am able to safely execute a free (without breathing gas) ascent from.


I understand that I may be required to furnish my own equipment and that I am responsible for its operating condition and maintenance.


I further state that I am of lawful age and legally competent to sign this liability release, or that I have acquired the written consent of my parent or guardian.


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 affect 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.


IT IS THE INTENTION OF, BY THIS INSTRUMENT TO EXEMPT AND RELEASE MY INSTRUCTORS, All Staff of Nautilus Aquatics, THE FACILITY THROUGH WHICH I RECEIVED MY INSTRUCTION Nautilus Aquatics, THE TRAINING AGENCY SDI AND INTERNATIONAL TRAINING AND SCUBA DIVING INTERNATIONAL, AND ALL OTHER RELATED ENTITIES AND RELEASED PARTIES AS DEFINED ABOVE, 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 PASSIVE OR ACTIVE. I HAVE FULLY INFORMED MYSELF OF THE CONTENTS OF THIS LIABILITY RELEASE AND EXPRESS ASSUMPTION OF RISK BY READING IT BEFORE SIGNING IT ON BEHALF OF MYSELF AND MY HEIRS.


This document is required for all courses and Specialties taught under sanction by Scuba Diving International. No alterations, changes, omissions or revisions may be made.

Today's date: April 20, 2024

 

Please select who will be participating...
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First Participant's Name

First Name*

Middle Name

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Information
Please Choose the course you are taking below...*

Diver Medical - Participant Questionnaire

Recreational scuba diving and freediving requires good physical and mental health. There are a few medical conditions which can be hazardous while diving, listed below. Those who have, or are predisposed to, any of these conditions, should be evaluated by a physician. This Diver Medical Participant Questionnaire provides a basis to determine if you should seek out that evaluation. If you have any concerns about your diving fitness not represented on this form, consult with your physician before diving. If you are feeling ill, avoid diving. If you think you may have a contagious disease, protect yourself and others by not participating in dive training and/or dive activities. References to "diving" on this form encompass both recreational scuba diving and freediving. This form is principally designed as an initial medical screen for new divers, but is also appropriate for divers taking continuing education. For your safety, and that of others who may dive with you, answer all questions honestly.

Directions

Complete this questionnaire as a prerequisite to a recreational scuba diving or freediving course.

Note to women: If you are pregnant, or attempting to become pregnant, do not dive.

1. I have had problems with my lungs, breathing, heart and/or blood affecting my normal physical or mental performance.**
2. I am over 45 years of age.**
3. I struggle to perform moderate exercise (for example, walk 1.6 kilometer/one mile in 14 minutes or swim 200 meters/yards without resting), OR I have been unable to participate in a normal physical activity due to fitness or health reasons within the past 12 months.*
4. I have had problems with my eyes, ears, or nasal passages/sinuses.**
5. I have had surgery within the last 12 months, OR I have ongoing problems related to past surgery.*
6. I have lost consciousness, had migraine headaches, seizures, stroke, significant head injury, or suffer from persistent neurologic injury or disease.**
7. I am currently undergoing treatment (or have required treatment within the last five years) for psychological problems, personality disorder, panic attacks, or an addiction to drugs or alcohol; or, I have been diagnosed with a learning disability.**
8. I have had back problems, hernia, ulcers, or diabetes.**
9. I have had stomach or intestine problems, including recent diarrhea.**
10. I am taking prescription medications (with the exception of birth control or anti-malarial drugs other than mefloquine/Lariam).*

If you answered NO to all 10 questions above, a medical evaluation is not required. Please go to the PARTICIPANT STATEMENT below to read and accept.

* If you answered YES to questions 3,5 or 10 above please read and agree to the Participant Statement below AND request the Participant Questionnaire and the Physician's Evaluation Form from your instructor or dive center to take to your physician for a medical evaluation. Participation in a diving course requires your physician's approval. 

** If you answered YES to questions 1, 2, 4, 6, 7, 8, or 9 please continue to the appropriate Box(es) below to complete your questionnaire to determine if participation in a diving course requires your physician's approval.


Box A - Complete this section if you answered YES to Question 1 above.

I have/have had:

Chest surgery, heart surgery, heart valve surgery, an implantable medical device (eg, stent, pacemaker, neurostimulator), pneumothorax, and/or chronic lung disease.
Asthma, wheezing, severe allergies, hay fever or congested airways within the last 12 months that limits my physical activity/exercise.
A problem or illness involving my heart such as: angina, chest pain on exertion, heart failure, immersion pulmonary edema, heart attack or stroke, OR am taking medication for any heart condition.
Recurrent bronchitis and currently coughing within the past 12 months, OR have been diagnosed with emphysema.
Symptoms affecting my lungs, breathing, heart and/or blood in the last 30 days that impair my physical or mental performance.

Box B - Complete this section if you answered YES to Question 2 above.

I am over 45 years of age AND:

I currently smoke or inhale nicotine by other means.
I have a high cholesterol level.
I have high blood pressure.
I have had a close blood relative die suddenly or of cardiac disease or stroke before the age of 50, OR have a family history of heart disease before age 50 (including abnormal heart rhythms, coronary artery disease or cardiomyopathy).

Box C - Complete this section if you answered YES to Question 4 above.

I have/have had:

Sinus surgery within the last 6 months.
Ear disease or ear surgery, hearing loss, or problems with balance.
Recurrent sinusitis within the past 12 months.
Eye surgery within the past 3 months.

Box D - Complete this section if you answered YES to Question 6 above.

I have/have had:

Head injury with loss of consciousness within the past 5 years.
Persistent neurologic injury or disease.
Recurring migraine headaches within the past 12 months, or take medications to prevent them.
Blackouts or fainting (full/partial loss of consciousness) within the last 5 years.
Epilepsy, seizures, or convulsions, OR take medications to prevent them.

Box E - Complete this section if you answered YES to Question 7 above.

I have/have had:

Behavioral health, mental or psychological problems requiring medical/psychiatric treatment.
Major depression, suicidal ideation, panic attacks, uncontrolled bipolar disorder requiring medication/psychiatric treatment.
Been diagnosed with a mental health condition or a learning/developmental disorder that requires ongoing care.
An addiction to drugs or alcohol requiring treatment within the last 5 years.

Box F - Complete this section if you answered YES to Question 8 above.

I have/have had:

Recurrent back problems in the last 6 months that limit my everyday activity.
Back or spinal surgery within the last 12 months.
Diabetes, either insulin- or diet-controlled, OR gestational diabetes within the last 12 months.
An uncorrected hernia that limits my physical abilities.
Active or untreated ulcers, problem wounds, or ulcer surgery within the last 6 months.

Box G - Complete this section if you answered YES to Question 9 above.

I have had:

Ostomy surgery and do not have medical clearance to swim or engage in physical activity.
Dehydration requiring medical intervention within the last 7 days.
Active or untreated stomach or intestinal ulcers or ulcer surgery within the last 6 months.
Frequent heartburn, regurgitation, or gastroesophageal reflux disease (GERD).
Active or uncontrolled ulcerative colitis or Crohn's disease.
Bariatric surgery within the last 12 months.

*If you answered YES to any of the questions in Boxes A, B, C, D, E, F or G, please read the Participant Statement below AND request the Participant Questionnaire and the Physician's Evaluation Form from your instructor or dive center to take to your physician for a medical evaluation. Participation in a diving course requires your physician's approval.

Participant Statement: I have answered all questions honestly, and understand that I accept responsibility for any consequences resulting from any questions I may have answered inaccurately or for my failure to disclose any existing or past health conditions.[today's date]

First Participant's Signature*
Participant's Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:*
City:*
State/Province:*
Zip/Postal:*
Parent or Guardian's Email Address

Email*

Confirm Email*
Emergency Contact

First Name*

Last Name*

Emergency Contact's Phone Number*
Photo/Media Release

I acknowledge that photos or videos taken during my course with Nautilus Aquatics, may include me or the undersigned minor(s).

I hereby authorize Diventures to publish photographs taken of me and/or the undersigned minor children, and/or names, for use in Diventures' marketing material, social media and website. I release Diventures from any expectation of confidentiality for the undersigned minor children and myself. I attest that I am the parent or legal guardian of the children listed below and that I have the authority to authorize Diventures to use their photographs and names.

I acknowledge that this photo participation is voluntary, and neither the minor children nor I will receive financial compensation. I further agree that our participation in any marketing piece produced by Diventures confers no rights of ownership whatsoever. I release Diventures, its contractors and its employees from liability for any claims by me or any third party in connection with my participation or the participation of the undersigned minor children.

Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.


By signing below the parent or court-appointed legal guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Middle Name

Last Name*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Information
Please Choose the course you are taking below...*

Diver Medical - Participant Questionnaire

Recreational scuba diving and freediving requires good physical and mental health. There are a few medical conditions which can be hazardous while diving, listed below. Those who have, or are predisposed to, any of these conditions, should be evaluated by a physician. This Diver Medical Participant Questionnaire provides a basis to determine if you should seek out that evaluation. If you have any concerns about your diving fitness not represented on this form, consult with your physician before diving. If you are feeling ill, avoid diving. If you think you may have a contagious disease, protect yourself and others by not participating in dive training and/or dive activities. References to "diving" on this form encompass both recreational scuba diving and freediving. This form is principally designed as an initial medical screen for new divers, but is also appropriate for divers taking continuing education. For your safety, and that of others who may dive with you, answer all questions honestly.

Directions

Complete this questionnaire as a prerequisite to a recreational scuba diving or freediving course.

Note to women: If you are pregnant, or attempting to become pregnant, do not dive.

1. I have had problems with my lungs, breathing, heart and/or blood affecting my normal physical or mental performance.**
2. I am over 45 years of age.**
3. I struggle to perform moderate exercise (for example, walk 1.6 kilometer/one mile in 14 minutes or swim 200 meters/yards without resting), OR I have been unable to participate in a normal physical activity due to fitness or health reasons within the past 12 months.*
4. I have had problems with my eyes, ears, or nasal passages/sinuses.**
5. I have had surgery within the last 12 months, OR I have ongoing problems related to past surgery.*
6. I have lost consciousness, had migraine headaches, seizures, stroke, significant head injury, or suffer from persistent neurologic injury or disease.**
7. I am currently undergoing treatment (or have required treatment within the last five years) for psychological problems, personality disorder, panic attacks, or an addiction to drugs or alcohol; or, I have been diagnosed with a learning disability.**
8. I have had back problems, hernia, ulcers, or diabetes.**
9. I have had stomach or intestine problems, including recent diarrhea.**
10. I am taking prescription medications (with the exception of birth control or anti-malarial drugs other than mefloquine/Lariam).*

If you answered NO to all 10 questions above, a medical evaluation is not required. Please go to the PARTICIPANT STATEMENT below to read and accept.

* If you answered YES to questions 3,5 or 10 above please read and agree to the Participant Statement below AND request the Participant Questionnaire and the Physician's Evaluation Form from your instructor or dive center to take to your physician for a medical evaluation. Participation in a diving course requires your physician's approval. 

** If you answered YES to questions 1, 2, 4, 6, 7, 8, or 9 please continue to the appropriate Box(es) below to complete your questionnaire to determine if participation in a diving course requires your physician's approval.


Box A - Complete this section if you answered YES to Question 1 above.

I have/have had:

Chest surgery, heart surgery, heart valve surgery, an implantable medical device (eg, stent, pacemaker, neurostimulator), pneumothorax, and/or chronic lung disease.
Asthma, wheezing, severe allergies, hay fever or congested airways within the last 12 months that limits my physical activity/exercise.
A problem or illness involving my heart such as: angina, chest pain on exertion, heart failure, immersion pulmonary edema, heart attack or stroke, OR am taking medication for any heart condition.
Recurrent bronchitis and currently coughing within the past 12 months, OR have been diagnosed with emphysema.
Symptoms affecting my lungs, breathing, heart and/or blood in the last 30 days that impair my physical or mental performance.

Box B - Complete this section if you answered YES to Question 2 above.

I am over 45 years of age AND:

I currently smoke or inhale nicotine by other means.
I have a high cholesterol level.
I have high blood pressure.
I have had a close blood relative die suddenly or of cardiac disease or stroke before the age of 50, OR have a family history of heart disease before age 50 (including abnormal heart rhythms, coronary artery disease or cardiomyopathy).

Box C - Complete this section if you answered YES to Question 4 above.

I have/have had:

Sinus surgery within the last 6 months.
Ear disease or ear surgery, hearing loss, or problems with balance.
Recurrent sinusitis within the past 12 months.
Eye surgery within the past 3 months.

Box D - Complete this section if you answered YES to Question 6 above.

I have/have had:

Head injury with loss of consciousness within the past 5 years.
Persistent neurologic injury or disease.
Recurring migraine headaches within the past 12 months, or take medications to prevent them.
Blackouts or fainting (full/partial loss of consciousness) within the last 5 years.
Epilepsy, seizures, or convulsions, OR take medications to prevent them.

Box E - Complete this section if you answered YES to Question 7 above.

I have/have had:

Behavioral health, mental or psychological problems requiring medical/psychiatric treatment.
Major depression, suicidal ideation, panic attacks, uncontrolled bipolar disorder requiring medication/psychiatric treatment.
Been diagnosed with a mental health condition or a learning/developmental disorder that requires ongoing care.
An addiction to drugs or alcohol requiring treatment within the last 5 years.

Box F - Complete this section if you answered YES to Question 8 above.

I have/have had:

Recurrent back problems in the last 6 months that limit my everyday activity.
Back or spinal surgery within the last 12 months.
Diabetes, either insulin- or diet-controlled, OR gestational diabetes within the last 12 months.
An uncorrected hernia that limits my physical abilities.
Active or untreated ulcers, problem wounds, or ulcer surgery within the last 6 months.

Box G - Complete this section if you answered YES to Question 9 above.

I have had:

Ostomy surgery and do not have medical clearance to swim or engage in physical activity.
Dehydration requiring medical intervention within the last 7 days.
Active or untreated stomach or intestinal ulcers or ulcer surgery within the last 6 months.
Frequent heartburn, regurgitation, or gastroesophageal reflux disease (GERD).
Active or uncontrolled ulcerative colitis or Crohn's disease.
Bariatric surgery within the last 12 months.

*If you answered YES to any of the questions in Boxes A, B, C, D, E, F or G, please read the Participant Statement below AND request the Participant Questionnaire and the Physician's Evaluation Form from your instructor or dive center to take to your physician for a medical evaluation. Participation in a diving course requires your physician's approval.

Participant Statement: I have answered all questions honestly, and understand that I accept responsibility for any consequences resulting from any questions I may have answered inaccurately or for my failure to disclose any existing or past health conditions.[today's date]

Parent or Guardian's Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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