Education PADI Documents

PADI TRAINING ENROLLMENT, MEDICAL DECLARATION & LIABILITY RELEASE

Participant Information

Date of Birth:    Student ID (if applicable):

Phone:    Email:

Relationship:    Phone:

Emergency Contact

Relationship:    Phone:

Course Enrollment & Fee Information

Course / Program:    Location:

Course Start Date:    Course End Date:

Prior Diving Experience

Have you completed prior scuba training?   Yes    No

Last dive date:    Maximum depth previously achieved:

Medical Declaration (PADI Medical Standards)

The participant must accurately answer the following. A "Yes" answer may require physician clearance prior to participation.

Do you currently have or have you had any of the following? (check all that apply)

Physician clearance required prior to participation?   Yes    No

If physician clearance required, Physician Name:    Phone:

Acknowledgment, Assumption of Risk & Release

I, the undersigned participant (or parent/guardian where applicable), certify that the statements in this enrollment and medical declaration are complete and accurate. I acknowledge that scuba diving is an adventure activity with inherent risks including but not limited to drowning, decompression sickness, barotrauma, equipment failure, hypothermia, and injury. I understand that it is my responsibility to withdraw from training if I believe conditions are unsafe or if my health prevents safe participation.

I voluntarily assume all risks associated with participation in this course. In consideration of being permitted to participate, I hereby release, indemnify, and hold harmless the dive center, its owners, officers, employees, agents, contractors, and instructors from any and all liability, claims, demands, causes of action, or legal responsibility arising out of or relating to my participation, including claims arising from the negligence of the dive center or its agents, to the fullest extent permitted by law.

I agree that any claim or dispute arising from my participation will be governed by the laws stated in the dive center's policies and that I will submit to the jurisdiction of the appropriate courts if legal action is initiated. If any provision of this release is held invalid, the remaining provisions shall remain in full force and effect.

Emergency treatment: I authorize the instructor and dive center to secure medical care for me (or for the minor in my care) in the event of injury or illness and accept financial responsibility for such care.

I further certify that I have read and understand the PADI standards and training materials relevant to this course, that I will follow all safe diving practices and instructions of my instructors, and that I will notify staff immediately of any change in medical status prior to or during training.

By checking the box below I attest to having read, understood, and agreed to the acknowledgment, assumption of risk, release, and emergency treatment authorization above.

I acknowledge and agree to the terms of the release, assumption of risk, and emergency treatment authorization.

Media Release & Certification Records

I consent to the use of photography or video taken of me during training for training records, certification verification, and promotional materials. I understand I may revoke consent in writing but that prior use is not affected.

I grant permission for photography/video use and certification record submission.

Cancellation, Refunds & Equipment

The dive center's cancellation and refund policy is a condition of enrollment. Deposits may be non-refundable. Refunds for course cancellations or failure to complete training are subject to evaluation based on delivered services, consumables, and third-party fees. The participant is responsible for loss or damage to rented equipment due to negligence.

I acknowledge the cancellation and refund policy and accept equipment responsibility terms.

Participant Certifications & Declarations

I certify under penalty of perjury that the information provided on this form is true, complete, and accurate. I understand that knowingly providing false information that affects fitness to dive may endanger myself and others and could invalidate insurance or certification.

Participant Printed Name:

If participant is under 18, Parent/Guardian Printed Name:

Facility / Instructor Information (to be completed by dive center)

Instructor Name:    Instructor ID/Cert #:

Final Declarations

The participant and the dive center agree that this form constitutes an integrated enrollment agreement and medical declaration for the stated course, and that signatures below bind the parties to the terms herein.

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