I , _____________________________________(name) hereby acknowledge that I have been advised and thoroughly informed of the inherent risks of scuba diving.

1. That diving with compressed air involves certain inherent risks of decompression sickness, embolism and other hyperbaric injuries and that such injuries may result in death or serious disablement.
2. That injuries of the type referred to in (1) above, may require treatment in a recompression chamber.
3. that open water diving trips which are necessary may be conducted at a site that is remote either by time and/or distance from a recompression chamber.
4. That scuba diving is a physically demanding activity and in susceptible individuals, may cause heart attack, panic or hyperventilation.
5. That scuba diving involves the use of equipment that may malfunction, giving rise to risk of death or disablement.
6. That scuba diving necessarily involves exposure to the natural elements including but without limiting the generality thereof, storm, tempest, wind, tides and marine life. Such exposure bring with it attendant risk of death or disablement.

I further acknowledge that having been advised of the risks associated with scuba diving, hereby release and hold harmless JEFFREY ROY GIDDINS and crew from any suit, demand or claim arising as a consequence of death or injury received by me during my said open water trip.

I further acknowledge that this document may be relied upon in any proceedings instituted in any Court by me or my heirs, executors and assigns.

NAME;___________________________________________________________________________________________________

ADDRESS;________________________________________________________________________________________________

PHONE NUMBERS - HOME;________________________________________MOBILE;____________________________________

EMAIL ADDRESS;__________________________________________________________________________________________

DIVE AGENCY _________________________________ & QUALIFICATIONS;_________________________________________

MAXIMUM DEPTH RATED;_________________________

STUDENT NUMBER;______________________________

WARNING:If you participate in these activities your rights to sue the supplier under the Fair Trading Act 1999 if you are killed or injured because the activities were not supplied with due care and skill or were not reasonably fit for their purpose, are excluded, restricted or modified in the way set out in or on this notice.

NOTE: The change to your rights, as set out in or on this notice, does not apply if your death or injury is due to gross negligence on the supplier's part. "Gross negligence" is defined in the Fair Trading(Recreational Services) Regulations 2004

SIGNATURE;_________________________________________________________

DATE;______________________________________________________________