Release and Assumption of Risk by a Student Engaging in Dangerous Activity
I, (Name of Releasor), of (street address, city, state, zip), affirm that I have previously completed
a certified beginning course of instruction in (e.g., scuba diving) prior to enrolling in this course.
By enrolling in this course, I certify that I am aware of all of the inherent dangers of (e.g., scuba
diving), and of the basic safety rules for activities connected with the same.
I understand that it is not the purpose of this course to teach safety rules, nor is it the function
of the instructors to serve as the guardians of my safety. I also understand that I am to furnish
my own equipment and I am responsible for its safety and good operating condition regardless
of where I obtain it.
I agree that neither owner(s) of this school, operators, employees, agents or instructors
(Releasees), may be held liable in any way for any occurrence in connection with (e.g., scuba
diving) which may result in injury, death or other damages to me or my family, heirs or assigns.
In consideration of being allowed to enroll in this course, I personally assume all risks in
connection with the course, and I further release the Releasees for any injury or damage that I
may incur while I am enr