NPLB Veteran Registration Form Logo
  • Veteran Application

    Thank you for your service and sacrifice! If you are interested in, or have been selected to attend a trip or event, please fill out the form below. Be sure to check each of your answers for accuracy. Your information will be kept confidential and safeguarded. Every attendee must complete this application in order to participate in an NPLB Outdoors event. If you hope to have a guest participate, they must also complete the Guest Event Release Form.






  • Note that some trips/events may not be conducive to service animals.


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  • In case of emergency...
  • HIPAA Release

    I understand and agree I could sustain a medical emergency while attending the event, and such medical emergency might relate to my current health status. I understand that sharing my health information is to ensure NPLB/CWVC event personnel are aware of my health-related matters in case I am involved in a medical emergency during the event. I authorize NPLB and CWVC to disclose my health information to event personnel, including personnel from NPLB/CWVC or other organizations/individuals involved in running the event. I authorize NPLB to disclose my medical data and information for the reasons described above, and release NPLB from any liability for disclosure under state and federal law. This HIPAA authorization and release shall be effective and valid from the date this application is executed and shall not expire. I understand that I am permitted to revoke this authorization and release. I understand, however, that it may be too late to revoke the authorization granted by me in this HIPAA release form if the information was already disclosed to event personnel.
  • Medical Information

    All information on this form is held confidentially and provides us with helpful information to assist in selection of and to ensure a successful experience for all participants. The undersigned understands that SCUBA diving is inherently dangerous and physically demanding. Therefore, participants must be without significant neurological, pulmonary, or respiratory issues, and be physically and mentally fit. The following questions are taken from the National Association of Underwater Instructors (NAUI) Medical Evaluation Checklist. Please check "Yes" or "No" to each question and provide details for any "Yes" responses in the Notes section.
  • 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.



  • Note that some trips/events may not be conducive to having an accompanying caregiver.  Each guest must submit an event release form.

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  • Carefully read and sign the section below

    TRIP RELEASE FORM:

    The undersigned acknowledges that his/her participation in a retreat or an event involves certain inherent risks of physical injury, illness and/or loss of personal property.


    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 Operation NPLB Outdoors.


    The undersigned by his/her execution of this trip release form hereby releases and holds harmless and forever discharges Operation 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 retreat or event.

     

    The undersigned further recognizes that if not for his/her execution of this release form, Operation NPLB Outdoors would not permit participation in a retreat 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.

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