PADI Discover Scuba® Diving Participant Statement
Read the following paragraphs carefully.
This statement, which includes a Medical Questionnaire, a Liability Release and Assumption of
Risk Agreement (Statement of Risks and Liability), Non-Agency Disclosure and Acknowledgment
and the Discover Scuba Diving Knowledge and Safety Review, informs you of some potential
risks involved in scuba diving and of the conduct required of you during the PADI Discover
Scuba Diving program. If you are a minor, your parent or guardian must read this Guide and
sign on the back panel.
You will also need to learn important safety rules regarding breathing and equalization while
scuba diving from the PADI Professional. Scuba diving and the use of scuba equipment without
proper supervision or instruction can result in serious injury or death. You must be instructed in
its use under the direct supervision of a qualified instructor.
PADI Medical Questionnaire
Scuba diving is an exciting and demanding activity. To scuba dive you must not be extremely
overweight or out of condition. Diving can be strenuous under certain conditions. Your
respiratory and circulatory systems must be in good health. All body air spaces must be normal
and healthy. A person with heart trouble, a current cold or congestion, epilepsy, asthma, a
severe medical problem, or who is under the influence of alcohol or drugs, should not dive.
If taking medication, consult your doctor before participating in this program.
The purpose of the Medical Questionnaire is to find out if you should be examined by a
physician before participating in recreational scuba diving. A positive response to a question
does not necessarily disqualify you from diving. A positive response means that there is a
preexisting condition that may affect your safety while diving and you must seek the advice
of a physician.
Please answer the following questions on your past and present medical history with a YES
or NO. If you are not sure, answer YES. If any of these items apply to you, we must request
that you consult with a physician prior to participating in scuba diving. Your PADI Professional
will supply you with a PADI Medical Statement and Guidelines for Recreational Scuba Diver’s
Physical Examination to take to a physician.
Non-Agency Disclosure and
Acknowledgment Agreement
I understand and agree that PADI Members (“Members”), including
and/or any individual PADI Instructors and Divemasters associated with the program in which
I am participating, are licensed to use various PADI Trademarks and to conduct PADI training,
but are not agents, employees or franchisees of PADI Americas, Inc, or its parent, subsidiary
and affiliated corporations (“PADI”). I further understand that Member business activities are
independent, and are neither owned nor operated by PADI, and that while PADI establishes
the standards for PADI diver training programs, it is not responsible for, nor does it have the
right to control, the operation of the Members’ business activities and the day-to-day conduct
of PADI programs and supervision of divers by the Members or their associated staff. I further
understand and agree on behalf of myself, my heirs and my estate that in the event of an injury
or death during this activity, neither I nor my estate shall seek to hold PADI liable for the actions,
inactions or negligence of
and/or the instructors and divemasters
associated with the activity.
Liability Release and Assumption
of Risk Agreement
I (participant name),
, hereby affirm that I aware that skin and
scuba diving have inherent risks which may result in serious injury or death.
I understand that diving with compressed air involves certain inherent risks; decompression
sickness, embolism or other hyperbaric injuries can occur that require treatment in a
recompression chamber. I further understand that this program may be conducted at a site that
is remote, either by time or distance or both, from such a recompression chamber. I still choose
to proceed with this program in spite of the absence of a recompression chamber or medical
facility in proximity to the dive site.
The information I have provided about my medical history on the Medical Questionnaire is
accurate to the best of my knowledge. I agree to accept responsibility for omissions regarding
my failure to disclose any existing or past health conditions.
I understand and agree that neither the dive professionals conducting this program, nor the
facility through which this program is offered,
, nor PADI
Americas, Inc., nor its affiliate or subsidiary corporations, nor any of their respective employees,
officers, agents or assigns (hereinafter referred to as “Released Parties”) may be held liable or
responsible in any way for any injury, death or other damages to me, my family, estate, heirs
or assigns that may occur as a result of my participation in this program or as a result of the
negligence of the Released Parties, whether passive or active.
In consideration of being allowed to participate in this program, I hereby personally assume all
risks for any harm, injury or damage, whether foreseen or unforeseen, that may befall me while participating in this program, including but not limited to the knowledge development, confined
water and/or open water activities.
I further release and hold harmless the Discover Scuba Diving program and the Released Parties
from any claim or lawsuit by me, my family, estate, heirs or assigns, arising out of my participation
in this program.
I further understand that skin diving and scuba diving are physically strenuous activities and that
I will be exerting myself during this program and that if I am injured as a result of heart attack,
panic, hyperventilation, etc., that I expressly assume the risk of said injuries and that I will not hold
the Released Parties responsible for the same.
I further state that I am of lawful age and legally competent to sign this Liability Release and
Assumption of Risk Agreement, 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 Agreement of my own free act and with the knowledge that I hereby agree to waive my
legal rights. I further agree that if any provision of this Agreement is found to be unenforceable
or invalid, that provision shall be severed from this Agreement. The remainder of this Agreement
will then be construed as though the unenforceable provision had never been contained herein.
I understand and agree that I am not only giving up my right to sue the Released Parties but
also any rights my heirs, assigns or beneficiaries may have to sue the Released Parties resulting
from my death. I further represent that I have the authority to do so and that my heirs, assigns
and beneficiaries will be estopped from claiming otherwise because of my representations to the
Released Parties.
I (participant name),
, BY THIS INSTRUMENT DO EXEMPT
AND RELEASE THE DIVE PROFESSIONALS CONDUCTING THIS PROGRAM, THE FACILITY
THROUGH WHICH THE PROGRAM IS CONDUCTED, AND PADI AMERICAS, INC., AND
ALL RELATED ENTITIES AND RELEASED PARTIES AS DEFINED ABOVE FROM ALL LIABILITY OR
RESPONSIBILITY WHATSOEVER FOR PERSONAL INJURY, PROPERTY DAMAGE OR WRONGFUL
DEATH, HOWEVER CAUSED, 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
ASSUMPTION OF RISK AGREEMENT AND NON-AGENCY DISCLOSURE ACKNOWLEDGMENT
AGREEMENT BY READING BOTH BEFORE SIGNING BELOW ON BEHALF OF MYSELF AND
MY HEIRS AND AFFIRM THE MEDICAL QUESTIONNAIRE IS ACCURATE.
