2025 Palau Trip Release Liability Forms (Certified Divers)

Palau Certified Diver Details
Name (as shown on Passport)*

First NameLast Name
Phone Number
Please enter a valid phone number.
Messenger Handle
WhatsApp Handle
Your Email Address
Are you certified Nitrox diver?*

YesNo, I'm diving air
What is your Height?*
What is your Weight?*
What is your Shoe Size?*
What is your age?
NOTE: This tour requires a level of physical activity dictating a good level off fitness. Physical disabilities or chronic diseases are contra-indicated for this tour.
Diving Experience
Total Dives to Date
Your Diving Certifications, mark (X)

BasicAdvancedNitroxRescueDive MasterInstructor
Rentals
Are you renting a full set of gear each day? Tanks and weights are included. ($75.00 a day or$375 for 5 days, mask, snorkel, fins, BCD, Regulator, wet suit, regs, gauges, computer:*

YesNo
Check Gear you need to rent:

Mask and snorkelFinsBCDReg & gaugesComputerWet Suit
Caroline's Resort
Check in time at Caroline’s on the 12th of January is: 2:00 PM.

Group meeting and orientation is at 2:30 PM same day at Caroline’s.

Check out time at Caroline’s on the 20th of January is 12:00 noon
Arrival at Koror International (ROR):
Airline Name*
Flight Number*
Arrival Date*
Arrival Time*
Departing from Koror International (ROR):
Airline name*
Flight Number*
Departing Date*
Departing Time*
Last Day January 18th out gassing time:
Please select one:*

yes I (we) wish to do the hike and picnic lunch to Ngardmau Waterfall.no, I (we) wish to chill at the Resort
ARRIVING PALAU BEFORE CHECK IN DATE (EARLY) AND/0R LEAVING PALAU (LATER) THAN THE TOUR DATES
Please Select One:*

Yes, please make reservations for us at a transition hotel before check in at Caroline’s Resort on the 21st.No, we will make (or have made) our own reservations if arriving earlyWe have already made reservations on an earlier arrival in order to transfer to Caroline’s for check in on the 21stYes: Please make reservations for us at a hotel near the airport for a transition to our departing flight at a date later than the 28th
If you have already made reservations on an earlier arrival, please specify the name of the hotel and the dates below:
RELEASE OF LIABILITY - READ BEFORE SIGNING
Name as it appears on your passport*

First NameLast Name
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
WHO TO CONTACT IN CASE OF AN EMERGENCY:
Name*
Relationship*
Phone Number*
Please enter a valid phone number.
WhatsApp/Messenger handle
Email Address of contact*
1. CANCELLATIONS: I Agree to text 619 341 1900 or email scubasd@aol.com not later than 12:01 a.m. October 1, 2024 in order to receive a full refund on canceling the monthly payment program for the 2025 Palau Dive Adventure or to text 610 341 1900 or email scubasd@aol.com by 12:01 am June 1, 2024 in order to receive a full refund of my $500.00 per person deposit holding my spot(s) for the 2025 Palau Dive Adventure. I understand that no refunds can be made after the above noted time and dates for either of the two payment and reservation hold programs.
I have read*

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RELEASE OF LIABILITY, WAIVER OF CLAIMS, AND EXPRESS ASSUMPTION OF RISK AGREEMENTPLEASE READ AND BE CERTAIN YOU UNDERSTAND THE IMPLICATIONS OF SIGNING THIS RELEASE

EXPRESS ASSUMPTION OF RISK ASSOCIATED WITH SNORKELING, APNEA DIVING, SCUBA DIVING, FIRST AID, AND RELATED ACTIVITIES
I, (PRINT PARTICIPANT LEGAL NAME)
hereby affirm and acknowledge that I have been fully informed of the inherent hazards and risks associated with Snorkeling, Apnea Diving, SCUBA Diving, First Aid, and instruction related thereto (“Diving Activities”). I fully understand that these hazards and risks can lead to severe injury and even loss of life. I understand that Snorkeling, Apnea Diving, SCUBA Diving, and First Aid activities may be conducted at a site that is remote from a recompression chamber and competent medical assistance. Nevertheless, I choose to proceed even in the absence of are compression chamber and competent medical assistance. Additionally, I understand that there are also hazards and risks associated with Snorkeling, Apnea Diving, SCUBA Diving, First Aid, and related travel, including, but not limited to the possible injury or loss of life as a result of a vessel accident, being hit by a vessel while in or under the water, while boarding, disembarking, exiting and/or reboarding the vessel to begin or end diving activities, equipment failure, user error, as well as during travel to and from dive sites. Despite the potential hazards and risks associated with Snorkeling, Apnea Diving SCUBA Diving, First Aid activities, and related activities which can include but are not limited to, aquatic life encounters, currents, waves, barotraumas (pressure change related injuries), sudden loss of visibility, entrapment underwater in wrecks, caves, vegetation, fishing line, fishing nets or debris, I wish to proceed and I freely accept and expressly assume all hazards and risks, that may arise from Snorkeling, Apnea Diving, SCUBA Diving, First Aid activities, and related activities which could result in personal injury, loss of life and property damage to me.
RELEASE OF LIABILITY AND WAIVER OF CLAIMS AGREEMENT:
In consideration of being allowed to participate in Snorkeling, Apnea Diving, SCUBA Diving, and First Aid activities as well as the use of any of the facilities and the use of the equipment of the below listed persons or entities, I hereby agree as follows:1. TO WAIVE AND RELEASE ANY AND ALL CLAIMS based upon negligence, active or passive with the exception of intentional, wanton or willful misconduct that I may have in the future against any of the following named persons or entities (hereinafter referred to as Releasees); National Association of Underwater Instructors, Inc. (NAUI) and subsidiary companies: Instructor/s and Leader/s) Rodney M. Watkins, his assigns, representatives and contractors(Facility/ies) Scuba San Diego Inc.(Others) City of San Diego, Department of Parks and Recreation2. To release the Releasees, their officers, directors, employees, representatives, agents and volunteers, from liability and responsibility, whatsoever, for any claims or causes of action that I, my estate, heirs, executors or assigns may have for personal injury, property damage or wrongful death arising from Snorkeling, Apnea Diving, SCUBA Diving, First Aid activities, and related activities whether caused by active or passive negligence of the Releasees or otherwise with the exception of gross negligence. By executing this Agreement, I agree to hold the Releasees harmless for any injury or loss of life which may occur to me during Snorkeling, Apnea Diving, SCUBA Diving, and First Aid activities and/or instruction, and any and all future courses of instruction, programs and Snorkeling, Apnea Diving, SCUBA Diving, and First Aid related travel I undertake.3. I fully understand that Snorkeling, Apnea Diving, SCUBA Diving, and First Aid related activities are physically strenuous and I will be exerting myself during this course of instruction. I understand and agree that if I am injured or killed as a result of heart a]ack, panic, hyperventilation, oxygen toxicity, hypoxia, narcosis, aquatic life encounters, drowning or any other cause, that I expressly assume the risk of these injuries and/or a]ended death and that I will not hold the Releasees included in this Agreement responsible in any other way.4. By entering into this Agreement, I am not relying on any oral or written representation or statements made by the Releasees, other than what is set forth in this Agreement. I further agree that this Agreement shall be governed by and interpreted in accordance with the laws of the State of Florida, United States of America.5. If any provision, section, subsection, clause or phrase of this Agreement is found to be unenforceable or invalid, that portion shall be severed from this Agreement. The remainder of this Agreement will then be construed as though the unenforceable portion had never been contained in the Agreement. The English language version of this document shall be controlling in all respects and shall prevail in case of any inconsistencies with translated versions. I fully understand that the terms of this Agreement are contractual in nature and not a mere recital. I further state by way of my signature I have signed this Agreement of my own free act. I hereby declare that I am of legal age and am competent to sign this Agreement or, if not, that my parent or legal guardian shall sign on my behalf, and that my parent or legal guardian is in complete understanding and concurrence with this Agreement.
I HAVE READ THIS AGREEMENT, I UNDERSTAND IT, I AGREE TO BE BOUND BY IT.

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Date

MonthDayYear
Date
Witness (Printed Name)
Witness Signature

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Signature of Parent OR Guardian If Participant Is a Minor, and by their signature they, on my behalf release all claims that both they and I have. Signature of Parent OR Guardian:

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Date

MonthDayYear
Date
Should be Empty:

Diving Experience

Rentals

Caroline's Resort

RELEASE OF LIABILITY - READ BEFORE SIGNING

WHO TO CONTACT IN CASE OF AN EMERGENCY:

RELEASE OF LIABILITY, WAIVER OF CLAIMS, AND EXPRESS ASSUMPTION OF RISK AGREEMENTPLEASE READ AND BE CERTAIN YOU UNDERSTAND THE IMPLICATIONS OF SIGNING THIS RELEASE