Form for Snorkeling - English

I hereby declare that I am aware that freediving has inherent risks that can result in serious injury. I understand and agree that neither my guide(s)/instructor(s) at ECOSCUBA CENTRO DE MERGULHO, nor the company through which the program was offered, nor International PADI, Inc., its affiliates and corporations, may be held liable or responsible in any way for any injury or other damage to me or my family as a result of my participation in this experience or as a result of the negligence of any party, including the Exempt Third Parties, whether passive or active. By allowing me to participate in this program, I hereby personally assume all risks of this program, whether foreseeable or not, that may befall me while participating in this program. I understand that freediving and snorkeling are physically demanding activities and that I will exert myself during this program. If I am injured as a result of a heart attack, panic, hyperventilation, drowning, or any other cause, I expressly assume the risk of such injuries and will not hold the Exempt Third Parties responsible for them. I understand that my past and current medical conditions may be contraindications for my participation in this experience. I affirm that I do not currently have a cold or flu, nor do I have an ear infection. I declare that I have no history of seizures, dizziness, or fainting, nor any history of heart problems (e.g., cardiovascular disease, angina, heart attack). I further affirm that I have no history of respiratory problems such as emphysema or tuberculosis. I declare that I am not currently taking any medications that carry a warning about any impairment of my physical or mental abilities. I further declare that I am of legal age and legally competent to sign this waiver, or that I have written permission from my parent or guardian. I understand that the terms listed herein are contractual and not a mere quotation, and that I have signed this document voluntarily and with the knowledge that I hereby agree to waive my legal rights.

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Participant's Name: *
Guardian's Name (if underage):
Age: *
E-mail: *
Phone: *
Height: *
Weight: *
Shoe Size: *
Date of Dive: *
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