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STATEMENT OF VOLUNTARY CONSENT, ASSUMPTION OF RISK,
GENERAL RELEASE AND WAIVER OF LIABILITY
FORT LOBSTERDALE LLC, a Florida limited liability company

I
hereby declare and affirm that:
Participant Name (Please Print Clearly)
(By initialing each paragraph, I affirm that I have read and fully understood the following)
______ 1. Being eighteen (18) years of age or older and having actual knowledge and conscious appreciation of the particular and inherent dangers involved in SCUBA DIVING and in the activities described herein, including, but not limited to open water environments, boat diving, beach diving, and all other water related activities do hereby voluntarily consent to my participation in the aforementioned activity and assume the risks arising there from.
______ 2. I understand that skin and scuba diving are physically strenuous activities and that I will be exerting myself during this activity. If I am injured as a result of this activity, including but not limited to, heart attack, panic, hyperventilation, drowning, hyperbaric injury, or any other cause, that I expressly assume the risk of said injuries and that I will not hold the FORT LOBSTERDALE LLC, a Florida limited liability company, and any and all agents, officer’s assistants and employees, either in their individual capacities or by reason of the relationship to the FORT LOBSTERDALE and their successors (hereinafter, collectively “FORT LOBSTERDALE”) responsible for the same.
______ 3. I declare that I am in good mental and physical fitness for this activity, and that I am not under the influence of alcohol, nor am I under the influence of any drugs that are contraindicated to my participation in this activity. If I am taking medication, I declare that I have seen a physician and have approval to participate in this activity while under the influence of the medication/drugs.
______ 4. I have successfully completed the necessary training, and hold the appropriate certification level(s), for the SCUBA diving activity in which I am engaged and participating in with the FORT LOBSTERDALE by a recognized SCUBA training agency, and my certification from said agency is currently valid and in good standing. I understand that diving with compressed air, breathing mixes other than air, including but not limited to NITROX, involves certain inherent risks. I further understand that this activity may be conducted at a site that is remote, either by time or distance or both, from a recompression chamber. I still choose to proceed with such activity in spite of the possible absence of a recompression chamber in proximity to the dive site.
______ 5. I understand that computer-driven software and SCUBA diving computers are capable of calculating decompression stop requirements and no-decompression times. These calculations are at best a guess of the real physiological decompression requirements. I SPECIFICALLY ASSUME ALL RISKS involved with my activities and the use of these devices.
______ 6. I will inspect all of my equipment prior to the activity. I will not hold the FORT LOBSTERDALE responsible for my failure to inspect my equipment prior to diving.
______ 7. I understand that from time to time the FORT LOBSTERDALE may provide me with some or all of my diving equipment or breathing gases, including any gases I might need in an emergency, and I 2 understand that I am solely responsible for inspecting any and all of the equipment used by me, and analyzing all of my dive gases prior to diving and hereby hold harmless and release and forever discharge the FORT LOBSTERDALE, and any and all agents, officer’s assistants and employees, either in their individual capacities or by reason of the relationship to the FORT LOBSTERDALE and their successors, from any and all claims and demands of NEGLIGENCE OR GROSS NEGLIGENCE whatsoever, which the undersigned and any of them, and the heirs, representatives, executors and administrators thereof, of any other persons acting in behalf, or in behalf of their respective agents, have or may have against the said FORT LOBSTERDALE, or any or all of the aforementioned persons or their successors, by reasons of any accident, illness, injury or death, or any other consequences arising or resulting directly or indirectly from the use of said diving equipment or breathing gases under the auspices of the FORT LOBSTERDALE occurring during said participation, or at any time subsequent thereto.
______ 8. I will be present at and attentive to any safety briefing given by the FORT LOBSTERDALE and/or their officers, agents, servants, and/or employees, and if there is anything that I do not understand or am not in agreement with, I will notify the FORT LOBSTERDALE immediately.
______ 9. I understand that I have a duty to plan and carry out my own dive and to be responsible for my own safety and should I elect to dive with a partner, it is to be an arrangement solely between that partner and myself. The FORT LOBSTERDALE, their officers, agents, servants, and/or employees are not responsible for providing me with a diving partner or in any way coordinating my dive with another diver.
______ 10. I understand and agree that neither FORT LOBSTERDALE, nor its affiliates; nor any of their respective employees, officers, agents or assigns, may be held liable or responsible in any way for any injury, death or other damages to me or my family, estate, heirs, or assigns that may occur as a result of my participation in this activity, or AS A RESULT OF ANY TYPE OF NEGLIGENCE, INCLUDING BY NOT LIMITED TO GROSS NEGLIGENCE, OF FORT LOBSTERDALE, OR ANY PARTY, HOWEVER CAUSED, WHETHER PASSIVE OR ACTIVE, and do hereby voluntarily consent to my participation in the aforementioned activity and assume the risks arising therefrom as well as hereby hold harmless and release and forever discharge the FORT LOBSTERDALE and any and all agents, officer’s assistants and employees, either in their individual capacities or by reason of the relationship to the FORT LOBSTERDALE and their successors, from any and all claims and demands whatsoever, which the undersigned and any of them, and the heirs, representatives, executors and administrators thereof, of any other persons acting in behalf, or in behalf of their respective agents, have or may have against FORT LOBSTERDALE, or any or all of the afore-mentioned persons or their successors, by reasons, including but not limited to NEGLIGENCE OR GROSS NEGLIGENCE, resulting in any accident, illness, injury or death, or any other consequences arising or resulting directly or indirectly from participation in SCUBA DIVING under the auspices of FORT LOBSTERDALE occurring during said participation, or at any time subsequent thereto

I HEREBY state that I am of lawful age and legally competent to sign this liability release. I understand 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 ay 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 un-enforceable provision had never been contained herein.
I UNDERSTAND AND AGREE THAT I AM NOT ONLY GIVING UP MY RIGHT TO SUE THE FORT LOBSTERDALE BUT ALSO ANY RIGHTS MY HEIRS, ASSIGNS, OR BENEFICIARIES MAY HAVE TO SUE THE RELEASE PARTIES RESULTING FROM MY DEATH AS A RESULT OF THE NEGLIGENCE OR GROSS NEGLIGENCE OF THE FORT LOBSTERDALE, OR ANY PARTY, 3 HOWEVER CAUSED, WHETHER PASSIVE OR ACTIVE. I FURTHER REPRESENT I HAVE THE AUTHORITY TO DO SO AND THAT MY HEIRS, ASSIGNS, OR BENEFICIARIES WILL BE ESTOPPED FROM CLAIMING OTHERWISE BECAUSE OF MY REPRESENTATIONS TO FORT LOBSTERDALE. I HAVE BEEN GIVEN THE OPPORTUNITY TO REVIEW THIS DOCUMENT WITH BOTH MY FAMILY, SPOUSE AND/OR LEGAL COUNSEL.
NOTICE TO THE MINOR CHILD’S
NATURAL GUARDIAN
READ THIS FORM COMPLETELY AND CAREFULLY. YOU ARE AGREEING TO LET YOUR MINOR CHILD ENGAGE IN A POTENTIALLY DANGEROUS ACTIVITY. YOU ARE AGREEING THAT, EVEN IF FORT LOBSTERDALE USES REASONABLE CARE IN PROVIDING THIS ACTIVITY, THERE IS A CHANCE YOUR CHILD MAY BE SERIOUSLY INJURED OR KILLED BY PARTICIPATING IN THIS ACTIVITY BECAUSE THERE ARE CERTAIN DANGERS INHERENT IN THE ACTIVITY WHICH CANNOT BE AVOIDED OR ELIMINATED. BY SIGNING THIS FORM YOU ARE GIVING UP YOUR CHILD’S RIGHT AND YOUR RIGHT TO RECOVER FROM FORT LOBSTERDALE IN A LAWSUIT FOR ANY PERSONAL INJURY, INCLUDING DEATH, TO YOUR CHILD OR ANY PROPERTY DAMAGE THAT RESULTS FROM THE RISKS THAT ARE A NATURAL PART OF THE ACTIVITY. YOU HAVE THE RIGHT TO REFUSE TO SIGN THIS FORM, AND FORT LOBSTERDALE HAS THE RIGHT TO REFUSE TO LET YOUR CHILD PARTICIPATE IF YOU DO NOT SIGN THIS FORM.
IN WITNESS WHEREOF, I have executed this instrument on this the
day of
20
Signature of Participant/Legal Guardian/Personal Representative
Printed Name of Participant/Legal Guardian/Personal Representative
If signed by Legal Guardian/Personal Representative, relationship to Participant: