Assign Points – South Shore SCUBA Club

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First Name*

Last Name*

Address 1*

Address 2

City*

Province*

Postal Code*

Country*

Phone*

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Password*

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Member Type*

Diver
Regular Member
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Certification Agency

Certification Number

Extra Certifications (DRAM, Nitrox, CPR etc.)

DAN (or other) Insurance Plan Number

Emergency Contact*

Emergency Contact Phone Number*

In consideration of my acceptance in the SOUTH SHORE SCUBA CLUB I hereby for myself my family, my invited guests, my heirs, executors release and forever discharge SOUTH SHORE SCUBA and its members from any and all actions, causes of action, claims and demands for damages, loss or injury. which may have been or may hereafter be sustained by me or them in consequence of my or their participation in any activity of the SOUTH SHORE SCUBA or my or their use of any of Its equipment or facilities.*

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