NPLB Guest Waiver

Guest Event Release Form

Thank you for supporting our veterans! We recognize the important role our veteran's family, friends and caretakers play in their recovery. Whenever possible, we are happy to accommodate their guests. If you are interested in, or have been selected to attend a trip or event as the guest of a veteran, please fill out the form below. Be sure to check each of your answers for accuracy. Your information will be kept confidential and safeguarded. If you are a veteran and completed the Veteran Application, you do not need to complete this form unless you are completing this on behalf of your children. Every attendee must complete this release form, or the release form on the veteran application in order to participate in an NPLB Outdoors event.
Are you completing this form form on behalf of yourself or as the legal guardian of your minor children?*

MyselfMy ChildrenBoth Myself and My Children
Which event will you be attending?
If unknown, type "unspecified"
Name of veteran you'll be attending with?*
Are you hoping to attend a SCUBA Trip as a diver?

YesNo
Are you SCUBA Certified?

YesNo
First Participant's Name*

First NameMiddle InitialLast Name
Second Participant's Name

First NameMiddle InitialLast Name
Third Participant's Name

First NameMiddle InitialLast Name
Fourth Participant's Name

First NameMiddle InitialLast Name
Fifth Participant's Name

First NameMiddle InitialLast Name
Address:*

Street Address

Street Address Line 2

CityState

Zip Code
Signer's Date of Birth*

MonthDayYear
Phone Number:*
E-mail*
example: mike@yahoo.com
List any physical restrictions or special needs including diet restrictions.
TRIP RELEASE FORM ACKNOWLEDGEMENT

If you are selected to attend the SCUBA Challenge and are not certified, you will be required to obtain written clearance to SCUBA dive from a physician and forward that clearance to NPLB prior to the event.   If you are a certified diver whose health has status changed in any material way since you were certified to dive and you answered “Yes” to any of the medical questions listed above, NPLB reserves the right to require you to obtain clearance to SCUBA dive from a physician. NPLB/CWVC Physicians will make such determinations after reviewing responses to the medical questions.

TRIP RELEASE FORM ACKNOWLEDGEMENT

The Undersigned affirms all statements contained in this application are true and correct and understand that false or inaccurate information in the application is grounds to deny application, rescind invitation, or revoke further support.

By executing this application, the Undersigned releases and holds harmless, and forever discharges, NPLB Outdoors, its directors, officers, volunteers, subcontractors, agents, and staff from all claims and causes of action of every kind or nature, foreseen and unforeseen, arising from or in any way connected with NPLB, this application, or any SCUBA event. The Undersigned further understands and agrees that the foregoing release is legally binding.

If selected to participate in the event, NPLB Outdoors will supply additional releases and waivers to each attendee for execution. Such documents may be supplied electronically or at the beginning of the event. The undersigned understands execution of such documents is mandatory to attend and participate in the event. Such documentation will include:

o   A comprehensive release and waiver by attendee for injury, death, and/or property damages.

o   A copyright assignment for photos and videos taken by attendee during the event;

o   A privacy and publicity release permitting CWVC to publish pictures/video of attendee;

o   A release and waiver required by dive vessels;

o   A HIPPA medical information release and waiver;

o   Medical research surveys; and

o   Other possible documentation.

The Undersigned recognizes that every effort will be made to obtain handicap accessible accommodations on Key West military installations during the event. However, there are instances where this may not be feasible. Under such circumstances, CWVC may utilize non-handicap accessible accommodations.

The Undersigned executes this application as of the date written below.
Carefully read and sign the section below

TRIP RELEASE FORM:

The undersigned acknowledges that his/her participation and/or their minor child's participation in an activity or an event involves certain inherent risks that could result in the loss of personal property, physical injury, illness, or even death.

The undersigned also affirms all statements contained in this application are true and correct and understand that false or inaccurate information will be the basis for denial and/or revocation for all support provided by NPLB Outdoors.

The undersigned by his/her execution of this trip release form hereby releases and holds harmless and forever discharges NPLB Outdoors and its officers, employees, directors, agents, volunteers, property owners, and staff from any and all claims, causes of action of whatsoever kind of nature, foreseen or unforeseen, arising from or in any way connected with a activity or event.

The undersigned further recognizes that if not for his/her execution of this release form, NPLB Outdoors would not permit participation in the activity or event.

The undersigned grants permission to use his/her image on photographs and/or video taken at NPLB Outdoors events in publications, news releases, online and in other communications related to the mission of NPLB Outdoors, at the discretion of NPLB Outdoors and without payment or other consideration.

The undersigned further certifies that he/she is an adult and has read the above information carefully before his/her execution of same and that he/she fully understands its terms.
I consent to receive communication by text message specifically related to event participation

YesNo
Participant's signature *
Signature of parent or legal guardian of guest(s) under 18 years of age.*
Type Name*

First NameLast Name
Should be Empty:

Guest Event Release Form