Waiver 2025 South Shore SCUBA Club Annual Waiver Fields marked with an * are required First Name * Last Name * Address * City * Province * - Select Province - Alberta British Columbia Manitoba New Brunswick Newfoundland & Labrador North West Territories Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon Territory Postal Code * Email * Confirm * Phone Number * Birth Date (Optional) Divider Sponsor (For New Members) Please check all that apply * Diver Regular Member Student Diver Family Member Non-Diver Member Certifying Agency SEI (SCUBA Educators) SDI/TDI PADI NAUI IANTD SSI Other Certification Number or ID Date Certified Certifications Achieved (SCUBA and Other) Open Water Diver Advanced Open Water Diver Nitrox Diver Rescue Diver (DRAM/SLAM) Ice Diver Divemaster Master Diver Assistant Instructor Instructor First Aid/CPR Oxygen Administration Average Dives Per Year Date of Last Dive Dive Insurance Provider Divers Alert Network (DAN) Other (Specify with number below) Insurance Number or ID Divider Allergies or Health Conditions * Put any allergies or medical conditions we need to be aware of such as medicinal, venom (sting), food allergies or heart/lung issues. Emergency Contact * Emergency Contact Phone Number * Waiver 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. By checking the box below, I agree to abide by the rules and bylaws of South Shore SCUBA Club. I also agree to the terms of this waiver. Signature * I Agree * Recaptcha If you are a human seeing this field, please leave it empty.
