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Sdi instructor manual part 5

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  • 1. SDIInstructor Manual Part 5 Appendix Forms All Rights Reserved, 1999 © By Scuba Diving International (SDI)
  • 2. Copyright 1999 © by Scuba Diving International (SDI).All rights reserved. Printed in the United States of America. Except as permitted under the Copyright Act of 1976,no part of this publication may be reproduced or distributed in any form or by any means, or stored in a database or retrieval system, without the prior written permission of the publisher. Scuba Diving International 18 Elm Street, Topsham, ME 04086 Phone: 207-729-4201 Toll Free: 888-778-9073 Fax: 207-729-4453 Web site: www.tdisdi.com E-mail: worldhq@tdisdi.com Business hours: Monday - Friday, 8:00 AM to 6:00 PM Eastern time
  • 3. SDI Instructor Manual Date: 11/19/04 Part 5 – Appendix Revision: 5.0 Table of Contents1. SDI Forms Overview ........................................................................................... iii 1.1 SDI – Scuba Diver Registration Form ............................................................................................iii 1.2 SDI – Medical Information Form.....................................................................................................iii 1.3 SDI – General Liability Release And Express Assumption Of Risk Forms....................................iii 1.4 SDI – Divemaster or Assistant Instructor Registration Form .........................................................iii 1.5 SDI – Scuba Diving Instructor Registration Form ..........................................................................iv 1.6 SDI – Specialty Upgrade Form for Instructors ...............................................................................iv 1.7 SDI – Open Water Global Referral Form .......................................................................................iv 1.8 SDI – Solo Release Form...............................................................................................................iv 1.9 SDI – Accident / Incident Report Form...........................................................................................iv 1.10 SDI – Academic Presentation Form...............................................................................................iv 1.11 SDI – In-Water Presentation Form .................................................................................................iv2. Forms .................................................................................................................... 1SDI Instructor Manual - Part Index i of iv5.doc
  • 4. SDI Instructor Manual Date: 11/19/04 Part 5 – Appendix Revision: 5.0 Revision History Revision Number Date Sections Changed 2.0 05/27/01 The Manual has been completely restructured and updated to reflect latest changes and additions. 2.1 10/10/02 Updated with latest Training Updates. 3.0 08/15/03 Updated with latest Training Updates. 3.1 12/23/03 2004 Renewal update. 5.0 11/19/04 Major update, changes on most forms.SDI Instructor Manual - Part Index ii of iv5.doc
  • 5. SDI Instructor Manual Date: 11/19/04 Part 5 – Appendix Revision: 5.01. SDI Forms Overview1.1 SDI – Scuba Diver Registration Form Use this form for the following 1. Open Water Scuba Diver 2. Junior Open Water Scuba Diver 3. Advanced Scuba Diver 4. Master Scuba Diver 5. CPROX Administrator 6. Rescue Diver 7. Specialty (Remember to specify which specialty)1.2 SDI – Medical Information Form Use this form to obtain medical information from the Students. Make sure to review the contents beforestarting on a course or specialty.1.3 SDI – General Liability Release And Express Assumption Of Risk Forms Use this form to obtain the General Liability Release from the Students. Make sure to review the contentsbefore starting on a course or specialty to ensure it has been completed and signed – including the signature of awitness. ONE FORM PER COURSE. 1. General Liability Release And Express Assumption Of Risk – for Teaching 2. General Liability Release And Express Assumption Of Risk - For Guided Scuba Tours For Certified Divers 3. General Liability Release And Express Assumption Of Risk - For Guided Snorkeling Tours 4. General Liability Release And Express Assumption Of Risk - For Unguided & Unsupervised Boat Dives For Certified Divers1.4 SDI – Divemaster or Assistant Instructor Registration Form Use this form to file for Divemaster or Assistant Instructor rating.SDI Instructor Manual - Part Index iii of iv5.doc
  • 6. SDI Instructor Manual Date: 11/19/04 Part 5 – Appendix Revision: 5.01.5 SDI – Scuba Diving Instructor Registration Form Use this form to file for Instructor rating.1.6 SDI – Specialty Upgrade Form for Instructors Use this form to file for specialty upgrades – for Instructors ONLY.1.7 SDI – Open Water Global Referral Form Use this form to when a student is traveling to another facility for the Open Water certification. Theprocedure is covered in Part 2 – Open Water Instructor Manual.1.8 SDI – Solo Release Form Use this form as the Solo Diver Liability Release.1.9 SDI – Accident / Incident Report Form Use this form to file information regarding an accident or incident with SDI Headquarter.1.10 SDI – Academic Presentation Form Use this form when preparing for the academic portion of a class. An example of its usage can be found inthe Academic portion of the Open Water Instructor Manual.1.11 SDI – In-Water Presentation Form Use this form when preparing for the confined portion of a class. An example of its usage can be found inthe In-Water portion of the Open Water Instructor Manual.SDI Instructor Manual - Part Index iv of iv5.doc
  • 7. 2. Forms
  • 8. Scuba Diver Registration Form 18 Elm St, Topsham, Maine 04086 Phone: 207-729-4201 Fax: 207-729-4453 Method of PaymentAMEX , MasterCard , Visa , Check or Money Order (Make Checks Payable to SDI) Exp. Date:Signature: Course: Check only ONE course per diver registration form Open Water Scuba Diver Junior Open Water Scuba Diver Advanced Scuba Diver Rescue Diver Specialty (Please specify): Master Scuba DiverCERTIFICATION FEE: C-Card Only* C-Card & Certificate* All diver c-cards & certificates are sent directly to the instructor or facility Print Name as it is to Complete Mailing Address Phone Number appear on C-Card (include City, State and Zip Code) E-mail Address ndCourse Completion Date (mm/dd/yy): 2 Inst./Asst. by: #: Freshwater Max training depth: Facility Name: Saltwater (Meter / feet):Instructor Name: Facility Number:Instructor’s SDI #: Ship To Address:Instructor Phone #:Instructor Address:I certify that the above named students have completed the SDI trainingcourse indicated and have reached the proficiency level required by SDI City:Standards before issuing these certifications. In addition, I agree to void all State:cards not issued within six months. Zip (or postal code):Instructor Signature (Required on each Form) Date Signed Country:Copyright © 2002 by Scuba Diving International (SDI) Revision 5.0, 11/29/04
  • 9. Scuba Diving International Medical Statement Participant Record (Confidential Information) 18 Elm Street, Topsham, Maine 04086 Phone: (207) 729-4201 Fax: (207) 729-4453 ---- Please read carefully before signing ----This is a statement in which you are informed of some When established safety procedures are not followed,potential risks involved in scuba diving and of the conduct however, there are dangers. To scuba dive safely, you must notrequired of you during the scuba-training program. Your be extremely overweight or out of condition. Diving can besignature on this statement is required for you to participate in strenuous under certain conditions. Your respiratory andthe scuba training program offered by circulatory systems must be in good health. All body air spaces must be normal and healthy. A person with heart trouble, a_____________________________________ and current cold or congestion, epilepsy, asthma, a severe medical Instructor problem or who is under the influence of alcohol or drugs should not dive. If taking medication, consult your doctor and the instructor before participation in this program. You will also need______________________________ located in the to learn from the instructor the important safety rules regarding Facility breathing and equalization while scuba diving. Improper use of scuba equipment can result in serious injury. You must beCity of ____________________ and State of _______ thoroughly instructed in its use under direct supervision of aRead and discuss this statement prior to signing it. You must qualified instructor to use it safely.complete this Medical Statement, which includes the medical-history section, to enroll in the scuba-training program. If you If you have any additional questions regarding this Medicalare a minor, you must have this statement signed by a parent. Statement or the Medical History section, review them with yourDiving is an exciting and demanding activity. When performed instructor before signing.correctly, applying correct techniques, it is very safe. MEDICAL HISTORY - To the ParticipantThe purpose of this medical questionnaire is to find out if your doctor should examine you before participating in recreational divetraining. A positive response to a question does not necessarily disqualify you from diving. A positive response means that there isa preexisting condition that may affect your safety while diving and you must seek the advice of your physician. Please answerEACH ONE the following questions on your past or present medical history with a YES or NO. If you are not sure, answer YES. Ifany of those items apply to you, we must request that you consult with a physician prior to participating in scuba diving.___ Are you pregnant? ___ History of diving accidents or decompression sickness? ___ History of recurrent back problems?Have you ever had or do you currently have: ___ History of back surgery?___ Do you have active asthma or history of emphysema or ___ Inability to perform moderate exercise (example: walk one tuberculosis? mile within 12 minutes)?___ Frequent or severe attacks of hay fever or allergy? ___ History of high blood pressure or take medicine to control___ Do you currently have a cold, sinusitis or bronchitis? blood pressure?___ Any form of lung disease? ___ History of any heart disease?___ Have you had a Pneumothorax (collapsed lung)? ___ History of heart attacks?___ History of chest surgery? ___ Angina or heart surgery or blood vessel surgery?___ Claustrophobia or agoraphobia (fear of closed or open ___ History of ear disease, hearing loss or problems with spaces)? balance?___ Epilepsy, seizures, convulsions or take medications to ___ History of drug or alcohol abuse? prevent them? ___ Do you currently have an ear infection?___ Recurring migraine headaches or take medications to ___ Are you currently taking medication that carries a warning prevent them? about any impairment of your physical or mental abilities?___ Do you have a history of diabetes? ___ Do you have a history of bleeding or other blood disorders?___ History of blackouts or fainting (full/partial loss of ___ Any other current medical condition that you feel could consciousness)? contradict participation in an active demanding sport such as scuba diving? The information I have provided about my medical history is accurate to the best of my knowledge.________________________________________________ _________________ Signature Date________________________________________________ _________________ Signatures of Parents or Guardians (Where Applicable) DateCopyright © 2002 by Scuba Diving International (SDI) Revision 5.0, 11/29/04
  • 10. STUDENT Please print legiblyName:______________________________________________________ Birth Date:____________ Age:______ First Initial LastMailing Address:_____________________________________________________________________________ _____________________________________________________________________________City:___________________________________________ State/ Province:_______________________________Country:_______________________________________ Zip / Postal Code:______________________________Phone: (_______)_______________________________ Fax: (_______)_________________________________ Name and address of your family or primary care physicianPhysician:__________________________________________ Clinic/ Hospital:___________________________Address:____________________________________________________________________________________ City State ZipPhone: (____)______________________________________ Date of last physical examination: ____ /____/____ mm / dd / yyName of examiner:__________________________________ Clinic/ Hospital:____________________________Address:_____________________________________________________ Phone: (______)_________________Were you ever required to have a physical for diving? Yes No If so, when? _________________________ PHYSICIANThis person is an applicant for training or is presently certified to engage in scuba (selfcontained underwater breathing apparatus) diving. Your opinion of the applicant’s medicalfitness for scuba diving is requested.Physician’s impression:____ I find no medical conditions that I consider incompatible with diving.____ I am unable to recommend this individual for diving.Remarks: __________________________________________________________________________________ __________________________________________________________________________________Physician:___________________________________________ Clinic/ Hospital:__________________________Address:____________________________________________________________________________________ City State ZipPhone: (________)__________________________ Fax: (________)________________________________Physicians Signature:_______________________________________________ Date ______/______/______ mm / dd / yy International Training, Inc.● 18 Elm Street ● Topsham ME 04086 Phone: (207) 729-4201● Fax: (207) 729-4453Copyright © 2002 by Scuba Diving International (SDI) Revision 5.0, 11/29/04
  • 11. General Liability Release And Express Assumption Of Risk 18 Elm Street, Topsham, Maine 04086 Phone: (207) 729-4201 Fax: (207) 729-4453For _____________________________________________ (specify Course or Specialty) training program undersanction through SDI. Please read carefully, fill in all blanks and initial each paragraph before signing at bottom.I, ______________________________, hereby affirm that I have been advised and thoroughly informed of the inherent hazards of scuba diving activities________ Further, I understand that diving with compressed air or oxygen enriched air (nitrox) involves certain inherent risks including decompression sickness, embolism, oxygen toxicity, inert gas narcosis, marine life injuries or other barotrauma/hyperbaric injuries can occur that require treatment in a recompression chamber. I further understand that the open water diving trips, which are necessary for training and certification, may be conducted at a site that is remote, either by time of distance or both, from such a recompression chamber. I still choose to proceed with such instructional dives in spite of the possible absence of a recompression chamber in proximity to the dive site.________ I understand and agree that neither my Instructor(s) ___________________________________, the facility through which I received my Instruction, ________________________________________, International Training and Scuba Diving International, nor the officers, directors, shareholders, affiliated companies, employees, agents, or assigns of the above listed entities and/or individuals, nor the authors of any materials including texts and tables expressly used for training and certification (hereinafter referred to as "Released Parties") may be held liable or responsible in any way for any injury, death, or other damages to me or my family, heirs, or assigns that may occur as a result of my participation in this diving class or as a result of the negligence of any party, including the Released Parties, whether passive or active.________ In consideration of being allowed to enroll in this course, I hereby personally assume all risks in connection with said course, for any harm, injury, or damage that may befall me while I am enrolled as a student of this course, including all risks connected therewith, whether foreseen or unforeseen.________ I further agree to save, defend, indemnify, and hold harmless said course and Released Parties from any claim or lawsuit by me, anyone purporting to act on my behalf, my family, estate, heirs or assigns, arising directly or indirectly out of my enrollment and participation in this course including both claims arising during the course or after I receive my certification even if such claims may be groundless, false or fraudulent.________ I also understand that diving activities are physically strenuous and that I will be exerting myself during this diving course, and that if I am injured as a result of heart attack, panic, hyperventilation, oxygen toxicity, inert gas narcosis, drowning, etc. that I expressly assume the risk of said injuries and that I will not hold the above listed individuals or companies responsible for the same, and I agree to defend, indemnify, and hold harmless said course and Released Parties for any such injuries incurred by me.________ I understand that these activities may place me deeper than I am able to safely execute a free (without breathing gas) ascent from.________ I understand that I may be required to furnish my own equipment and that I am responsible for its operating condition and maintenance.________ I further state that I am of lawful age and legally competent to sign this liability release, or that I have acquired the written consent of my parent or guardian.________ I understand that the terms herein are contractual and not a mere recital, and that I have signed this document of my own free act. Further that I understand and agree that, in the event that one or more of the provisions of this agreement, for any reason, is held by a court of competent jurisdiction to be invalid or unenforceable in any respect, such invalidity, illegality or unenforceability shall not affect any other provision hereof, and this agreement shall be construed as if such invalid, illegal or unenforceable provision or provisions had never been contained herein.IT IS THE INTENTION OF ____________________________________ BY THIS INSTRUMENT TO EXEMPT AND RELEASE MYINSTRUCTORS, _________________________ (AND OTHERS, _________________________), THE FACILITYTHROUGH WHICH I RECEIVED MY INSTRUCTION ______________________________, THE TRAINING AGENCY_________________________ AND INTERNATIONAL TRAINING INC. AND SCUBA DIVING INTERNATIONAL, AND ALLOTHER RELATED ENTITIES AND RELEASED PARTIES AS DEFINED ABOVE, FROM ALL LIABILITY OR RESPONSIBILITYWHATSOEVER FOR PERSONAL INJURY, PROPERTY DAMAGE OR WRONGFUL DEATH HOWEVER CAUSED, OR ARISINGOUT OF, DIRECTLY OR INDIRECTLY, INCLUDING, BUT NOT LIMITED TO, THE NEGLIGENCE OF THE RELEASED PARTIES,WHETHER PASSIVE OR ACTIVE. I HAVE FULLY INFORMED MYSELF OF THE CONTENTS OF THIS LIABILITY RELEASE ANDEXPRESS ASSUMPTION OF RISK BY READING IT BEFORE SIGNING IT ON BEHALF OF MYSELF AND MY HEIRS. This document is required for all courses and Specialties taught under sanction by Scuba Diving International. No alterations, changes, omissions or revisions may be made._______________________________ ___________________________ Signature of Student/Participant / Date Signatures of Parents or Guardians / Date (where applicable)_______________________________ Witness / DateCopyright© 2002 by Scuba Diving International (SDI) Revision 5.0, 11/29/04
  • 12. General Liability Release And Express Assumption Of Risk 18 Elm Street, Topsham, Maine 04086 Phone: (207) 729-4201 Fax: (207) 729-4453 For Guided Scuba Tours For Certified Divers Please read carefully, fill in all blanks and initial each paragraph before signing at bottom.I, ______________________________, hereby affirm that I have been advised and thoroughly informed of the inherent hazards of scuba divingactivities and participation in a guided tour as a diver.________ Further, I understand that diving with compressed air, oxygen enriched air (Nitrox), and trimix supplied by standard open circuit scuba or with semi-closed circuit or closed circuit rebreathers involves certain inherent risks including decompression sickness, embolism, oxygen toxicity, inert gas narcosis, hypoxia, hypercapnia, marine life injuries or other barotrauma or hyperbaric injuries. Such injuries can occur that require treatment in a recompression chamber or medical facility. I further understand that dive activities can be at remote sites, and isolated by time and distance, from such a recompression chamber or medical facility. I still choose to proceed with such dives in spite of the absence of a recompression chamber in proximity to the dive site.________ I understand and agree that neither the instructor/guide ___________________________________, nor any of the respective employees, officers, agents or assigns of ________________________________________, (hereinafter referred to as "Released Parties") may be held liable or responsible in any way for any injury, death, or other damages to me or my family, heirs, or assigns that may occur as a result of my participation in this diving activity or as a result of the negligence of any party, including the Released Parties, whether passive or active.________ In consideration of being allowed to participate in this activity I hereby personally assume all risks in connection with said trip, for any harm, injury, or damage that may befall me while I am a diving participant including all risks connected therewith, whether foreseen or unforeseen.________ I further agree to save, defend, indemnify, and hold harmless said Released Parties from any claim or lawsuit by me, anyone purporting to act on my behalf, my family, estate, heirs or assigns, arising directly or indirectly out of my participation and diving activities including claims arising during this activity even if such claims may be groundless, false or fraudulent.________ I also understand that diving activities are physically strenuous and that I will be exerting myself during this diving trip and that if I am injured as a result of heart attack, panic, hyperventilation, oxygen toxicity, inert gas narcosis, drowning, etc. that I expressly assume the risk of said injuries and that I will not hold the above listed individuals or companies responsible for the same, and I agree to defend, indemnify, and hold harmless said Released Parties for any such injuries incurred by me.________ I understand that these activities may place me deeper than I am able to safely execute a free ascent (without breathing gas)from.________ I understand that I may be required to furnish some of my own equipment and that I am responsible for its operating condition and maintenance.________ I understand that I may be supplied with certain items of scuba equipment and that I am responsible for reviewing its proper function and operating condition prior to using it.________ I further state that I am of lawful age and legally competent to sign this liability release, or that I have acquired the written consent of my parent or guardian.________ I further state that I am already a qualified and certified scuba diver from the following training agencies: ______________________, and that I hold training to the level of ________________________. I am aware of the required certification level and/or experience necessary and recommended to enroll in this diving activity and I stipulate that I meet requirements for prior certification or equivalent experience. I have been a certified diver since ______ and have been diving for _____ years for a total of ______ dives to a maximum depth of ____ ft._______ I understand that the terms herein are contractual and not a mere recital, and that I have signed this document of my own free act. Further that I understand and agree that, in the event that one or more of the provisions of this agreement, for any reason, is held by a court of competent jurisdiction to be invalid or unenforceable in any respect, such invalidity, illegality or unenforceability shall not affect any other provision hereof, and this agreement shall be construed as if such invalid, illegal or unenforceable provision or provisions had never been contained herein.IT IS THE INTENTION OF ____________________________________ BY THIS INSTRUMENT TO EXEMPT AND RELEASE MYINSTRUCTORS DIVEMASTER/GUIDE, _________________________ THE BUSINESS, _________________________), AND ALL OTHERRELATED ENTITIES AND RELEASED PARTIES AS DEFINED ABOVE, FROM ALL LIABILITY OR RESPONSIBILITY WHATSOEVER FORPERSONAL INJURY, PROPERTY DAMAGE OR WRONGFUL DEATH HOWEVER CAUSED, OR ARISING OUT OF, DIRECTLY ORINDIRECTLY, INCLUDING, BUT NOT LIMITED TO, THE NEGLIGENCE OF THE RELEASED PARTIES, WHETHER PASSIVE OR ACTIVE. IHAVE FULLY INFORMED MYSELF OF THE CONTENTS OF THIS LIABILITY RELEASE AND EXPRESS ASSUMPTION OF RISK BYREADING IT BEFORE SIGNING IT ON BEHALF OF MYSELF AND MY HEIRS._______________________________ ___________________________ Signature of Student/Participant / Date Signatures of Parents or Guardians / Date (where applicable)_______________________________ Witness / DateCopyright © 2002 by Scuba Diving International (SDI) Revision 1.0, 12/23/03
  • 13. General Liability Release And Express Assumption Of Risk 18 Elm Street, Topsham, Maine 04086 Phone: (207) 729-4201 Fax: (207) 729-4453 For Guided Snorkeling Tours Please read carefully, fill in all blanks and initial each paragraph before signing at bottom.I, ______________________________, hereby affirm that I have been advised and thoroughly informed of the inherent hazards of snorkelingactivities and participation in a guided tour as a snorkeler.________ Further, I understand that snorkeling involves certain inherent risks including marine life injuries, drowning, slipping & falling on either a vessel or a beach entry point, possible hazards from other watercraft or vessels in the area or other barotrauma injuries such as ear or mask squeezes, etc. Such injuries can occur that may require treatment in a medical facility. I further understand that snorkeling activities can be at remote sites, and isolated by time and distance, from such a medical facility. I still choose to proceed with such snorkeling activities in spite of the absence of a medical facility in proximity to the snorkeling site.________ I understand and agree that neither the instructor/guide ___________________________________, nor any of the respective employees, officers, agents or assigns of ________________________________________, (hereinafter referred to as "Released Parties") may be held liable or responsible in any way for any injury, death, or other damages to me or my family, heirs, or assigns that may occur as a result of my participation in this snorkeling activity or as a result of the negligence of any party, including the Released Parties, whether passive or active.________ In consideration of being allowed to participate in this activity I hereby personally assume all risks in connection with said trip, for any harm, injury, or damage that may befall me while I am a snorkeling participant including all risks connected therewith, whether foreseen or unforeseen.________ I further agree to save, defend, indemnify, and hold harmless said Released Parties from any claim or lawsuit by me, anyone purporting to act on my behalf, my family, estate, heirs or assigns, arising directly or indirectly out of my participation and snorkeling activities including claims arising during this activity even if such claims may be groundless, false or fraudulent.________ I also understand that snorkeling activities are physically strenuous and that I will be exerting myself during this snorkeling trip and that if I am injured as a result of heart attack, panic, hyperventilation, drowning, etc. that I expressly assume the risk of said injuries and that I will not hold the above listed individuals or companies responsible for the same, and I agree to defend, indemnify, and hold harmless said Released Parties for any such injuries incurred by me.________ I understand that I may be required to furnish some of my own equipment and that I am responsible for its operating condition and maintenance..________ I understand that I may be supplied with certain items of snorkeling equipment and that I am responsible for reviewing its proper function, fit, and operating condition prior to using it.________ I further state that I am of lawful age and legally competent to sign this liability release, or that I have acquired the written consent of my parent or guardian.________ I understand that the terms herein are contractual and not a mere recital, and that I have signed this document of my own free act. Further that I understand and agree that, in the event that one or more of the provisions of this agreement, for any reason, is held by a court of competent jurisdiction to be invalid or unenforceable in any respect, such invalidity, illegality or unenforceability shall not affect any other provision hereof, and this agreement shall be construed as if such invalid, illegal or unenforceable provision or provisions had never been contained herein.IT IS THE INTENTION OF ____________________________________ BY THIS INSTRUMENT TO EXEMPT AND RELEASE MYINSTRUCTORS DIVEMASTER/GUIDE, _________________________ THE BUSINESS, _________________________), AND ALL OTHERRELATED ENTITIES AND RELEASED PARTIES AS DEFINED ABOVE, FROM ALL LIABILITY OR RESPONSIBILITY WHATSOEVER FORPERSONAL INJURY, PROPERTY DAMAGE OR WRONGFUL DEATH HOWEVER CAUSED, OR ARISING OUT OF, DIRECTLY ORINDIRECTLY, INCLUDING, BUT NOT LIMITED TO, THE NEGLIGENCE OF THE RELEASED PARTIES, WHETHER PASSIVE OR ACTIVE. IHAVE FULLY INFORMED MYSELF OF THE CONTENTS OF THIS LIABILITY RELEASE AND EXPRESS ASSUMPTION OF RISK BYREADING IT BEFORE SIGNING IT ON BEHALF OF MYSELF AND MY HEIRS._______________________________ ___________________________ Signature of Student/Participant / Date Signatures of Parents or Guardians / Date (where applicable)_______________________________ Witness / DateCopyright © 2002 by Scuba Diving International (SDI) Revision 1.0, 12/23/03
  • 14. General Liability Release And Express Assumption Of Risk 18 Elm Street, Topsham, Maine 04086 Phone: (207) 729-4201 Fax: (207) 729-4453 For Unguided & Unsupervised Boat Dives For Certified Divers Please read carefully, fill in all blanks and initial each paragraph before signing at bottom.I, ______________________________, hereby affirm that I have been advised and thoroughly informed of the inherent hazards of scuba diving activities and participation in a guided tour as a diver.________ Further, I understand that diving with compressed air, oxygen enriched air (Nitrox), and trimix supplied by standard open circuit scuba or with semi-closed circuit or closed circuit rebreathers involves certain inherent risks including decompression sickness, embolism, oxygen toxicity, inert gas narcosis, hypoxia, hypercapnia, marine life injuries or other barotrauma or hyperbaric injuries. Such injuries can occur that require treatment in a recompression chamber or medical facility. I further understand that dive activities can be at remote sites, and isolated by time and distance, from such a recompression chamber or medical facility. I still choose to proceed with such dives in spite of the absence of a recompression chamber in proximity to the dive site.________ I understand and agree that neither the captain and crew ___________________________________, nor the vessel_______________________, nor any of the respective employees, officers, agents or assigns of ________________________________________, (hereinafter referred to as "Released Parties") may be held liable or responsible in any way for any injury, death, or other damages to me or my family, heirs, or assigns that may occur as a result of my participation in this diving activity or as a result of the negligence of any party, including the Released Parties, whether passive or active.________ In consideration of being allowed to participate in this activity I hereby personally assume all risks in connection with said trip, for any harm, injury, or damage that may befall me while I am a diving participant including all risks connected therewith, whether foreseen or unforeseen.________ I further agree to save, defend, indemnify, and hold harmless said Released Parties from any claim or lawsuit by me, anyone purporting to act on my behalf, my family, estate, heirs or assigns, arising directly or indirectly out of my participation and diving activities including claims arising during this activity even if such claims may be groundless, false or fraudulent.________ I also understand that diving activities are physically strenuous and that I will be exerting myself during this diving trip and that if I am injured as a result of heart attack, panic, hyperventilation, oxygen toxicity, inert gas narcosis, drowning, etc. that I expressly assume the risk of said injuries and that I will not hold the above listed individuals or companies responsible for the same, and I agree to defend, indemnify, and hold harmless said Released Parties for any such injuries incurred by me.________ I understand that these activities may place me deeper than I am able to safely execute a free ascent (without breathing gas) from.________ I understand that I may be required to furnish some of my own equipment and that I am responsible for its operating condition and maintenance.________ I understand that I may be supplied with certain items of scuba equipment and that I am responsible for reviewing its proper function and operating condition prior to using it.________ I further state that I am of lawful age and legally competent to sign this liability release, or that I have acquired the written consent of my parent or guardian.________ I further state that I am already a qualified and certified scuba diver from the following training agencies:__________________________, and that I hold training to the level of _____________________________________. I am aware of the required certification level and/or experience necessary and recommended to enroll in this diving activity and I stipulate that I meet those requirements for prior certification or equivalent experience. I have been a certified diver since ________ and have been diving for _____ years for a total of ______ dives to a maximum depth of ____ ft.________ I understand that the terms herein are contractual and not a mere recital, and that I have signed this document of my own free act. Further that I understand and agree that, in the event that one or more of the provisions of this agreement, for any reason, is held by a court of competent jurisdiction to be invalid or unenforceable in any respect, such invalidity, illegality or unenforceability shall not affect any other provision hereof, and this agreement shall be construed as if such invalid, illegal or unenforceable provision or provisions had never been contained herein.IT IS THE INTENTION OF ____________________________________ BY THIS INSTRUMENT TO EXEMPT AND RELEASE THECAPTAIN/CREW___________________________________________, THE VESSEL ______________________________THEBUSINESS_________________________________ AND ALL OTHER RELATED ENTITIES AND RELEASED PARTIES AS DEFINED ABOVE,FROM ALL LIABILITY OR RESPONSIBILITY WHATSOEVER FOR PERSONAL INJURY, PROPERTY DAMAGE OR WRONGFUL DEATHHOWEVER CAUSED, OR ARISING OUT OF, DIRECTLY OR INDIRECTLY, INCLUDING, BUT NOT LIMITED TO, THE NEGLIGENCE OF THERELEASED PARTIES, WHETHER PASSIVE OR ACTIVE. I HAVE FULLY INFORMED MYSELF OF THE CONTENTS OF THIS LIABILITYRELEASE AND EXPRESS ASSUMPTION OF RISK BY READING IT BEFORE SIGNING IT ON BEHALF OF MYSELF AND MY HEIRS._______________________________ ___________________________ Signature of Student/Participant / Date Signatures of Parents or Guardians / Date (where applicable)_______________________________ Witness / DateCopyright © 2002 by Scuba Diving International (SDI) Revision 1.0, 12/23/03
  • 15. Divemaster or Assistant Instructor Registration Form 18 Elm Street, Topsham, Maine 04086 Phone: (207) 729-4201 Fax: (207) 729-4453 Method of PaymentAMEX , MasterCard , Visa , Check or Money Order (Make Checks Payable to SDI) Exp. Date:Signature: Certificates & cards are sent directly to the instructor or facility. Certification Fee: Refer to current price list Please Check One Only: DIVEMASTER ASSISTANT INSTRUCTORPrint Name As It Is To Appear OnCertification CardComplete Mailing Address(including City, State and Zip Code)Phone NumberE-mail Address ndCourse Completion Date (mm/dd/yy): 2 Inst./Asst. by: #: Freshwater Max training depth: Facility Name: Saltwater (Meter / feet):Instructor Name: Facility Number:Instructor’s SDI #: Ship To Address:Instructor Phone #:Instructor Address:I certify that the above named students have completed the SDI training courseindicated and have reached the proficiency level required by SDI Standards before City:issuing these certifications. In addition, I agree to void all cards not issued within six State:months. Zip (or postal code):Instructor Signature (Required on each Form) Date Signed Country:Copyright© 2002 by Scuba Diving International (SDI) Revision 5.0, 11/29/04
  • 16. Scuba Diving Instructor Registration Form 18 Elm Street, Topsham, Maine 04086 Phone: (207) 729-4201 Fax: (207) 729-4453Note The Instructor Application must accompany this form Method of PaymentAMEX , MasterCard , Visa , Check or Money Order (Make Checks Payable to SDI) Exp. Date:Signature:Other Instructor Ratings: ANDI # PADI # PSA #IANTD # YMCA # NAUI # SSI #NASDS # Other (Specify): # Certificates & cards are sent directly to the instructor or facility. Certification Fee: * Instructor Upgrade Fee: * * Refer to current price list Specify Upgrade Rating:____________________________Print Name As It Is ToAppear On Certification CardComplete Mailing Address(including City, State and ZipCode)Phone NumberE-mail Address ndCourse Completion Date (mm/dd/yy): 2 Inst./Asst. by: #: Freshwater Max training depth: Facility Name: Saltwater (Meter / feet):Instructor Name: Facility Number:Instructor’s SDI #: Ship To Address:Instructor Phone #:Instructor Address:I certify that the above named students have completed the SDI trainingcourse indicated and have reached the proficiency level required by SDI City:Standards before issuing these certifications. In addition, I agree to void all State:cards not issued within six months. Zip (or postal code):Instructor Signature (Required on each Form) Date Signed Country:Copyright © 2002 by Scuba Diving International (SDI) Revision 5.0, 11/29/04
  • 17. Specialty Upgrade Form For Instructors Only 18 Elm Street, Topsham, Maine 04086 Phone: (207) 729-4201 Fax: (207) 729-4453 Method of PaymentAMEX , MasterCard , Visa , Check or Money Order (Make Checks Payable to SDI) Exp. Date:Signature: Certificates & cards are sent directly to the instructor or facility. Certification Fee: * Refer to current price list Please Check Only One Course Per Form Advanced Buoyancy Control Equipment Specialist Underwater Video Altitude Ice VIP Boat Marine Ecosystems Awareness Wreck Computer Diver Night /Limited Visibility Other: (Specify) Computer Nitrox Diver Research CPROX Administrator Search & Recovery CPR1st Administrator Shore/Beach Deep Diving (130 ft Max) U/W Hunter & Collector Diver Propulsion Vehicle U/W Navigation Drift Diver U/W Photography Dry Suit U/W Video Current Instructor Number:Print Name As It Is To AppearOn Certification CardComplete Mailing Address(including City, State and ZipCode)Phone NumberE-mail Address Please fill out the appropriate section on Page 2 BEFORE submitting the form to SDI Specialty Upgrade Form – For Instructors OnlyCopyright © 2002 by Scuba Diving International (SDI) Revision 5.0, 11/29/04
  • 18. Specialty Procedure #1 Participation in an Instructor Specialty Class A SDI Instructor has completed an SDI Specialty Instructor Course. Instructor Requirements: A. I agree to adhere to the SDI Specialty Course standard and outline provided by SDI Headquarters. B. Documentation of 10 dives in that particular specialty course. Course Location: _____________________________ Course Completion Date: ___/___/___ Instructor Trainer Signature: ____________________ SDI #________ Date: ___/___/__ Instructor Signature: ___________________________________________ Date: ___/___/___ Specialty Procedure # Administrative Specialty Instructor Upgrade An instructor who wishes to crossover his/her specialty instructor rating from another certification agency to SDI. OR An instructor who feels his/her experience in a particular specialty meets the requirements to teach a SDI specialty course. Instructor Requirements: A. I agree to adhere to the SDI Specialty Course standard and outline provided by SDI Headquarters. B. Documentation of 25 dives in that particular specialty course. Instructor Signature: ________________________________________ Date: ___/___/___ Specialty Procedure #3 Request for a Specialty Instructor Upgrade An instructor who has a specialty rating that is not listed as one of the SDI Specialty courses, can apply for specialty course recognition. Instructor Requirements: A. I agree to provide SDI Headquarters with the specialty course outline B. Complete Documentation of dive history plus documentation of 20 dives in that particular specialty course. Instructor Signature: ________________________________________ Date: ___/___/___Dive History:Specialty Upgrade Form – For Instructors Only Page 2 of 2Copyright © 2002 by Scuba Diving International (SDI) Revision 5.0, 11/29/04
  • 19. Open Water Global Referral Form 18 Elm Street, Topsham, Maine 04086 Phone: (207) 729-4201 Fax: (207) 729-4453 Student Information:Name:Address:City: State:Zip: Country:Phone: Fax:Email: Birth Date:Age: Sex: M F Original Instructor:Facility: Phone:Instructor’s Name:Address:City: State:Zip: Country:Phone: Fax:Email: SDI Instructor #: I agree that the above named student has successfully fulfilled all of the academic andconfined water requirements for SDI’s Open Water Scuba Diving course. As indicated by thesignature below I believe the student is mentally and physically prepared to participate in openwater training.Instructor Signature: _____________________________ Completion Date: ____/____/____Check List for Original Instructor:____ A Copy of the student’s Medical History must accompany this referral form.____ A Signed and Completed SDI Scuba Diver Referral Form.____ Remind student to take along his/her diver logbook and dive computer. Expiration Date: Valid for 6 Months from completion dateOpen Water Global Referral Form Page 1 of 3Copyright © 2002 by Scuba Diving International (SDI) Revision 2.1, 10/10/02
  • 20. Open Water Global Referral Form 18 Elm Street, Topsham, Maine 04086 Phone: (207) 729-4201 Fax: (207) 729-4453 EVALUATING OPEN WATER INSTRUCTORDear evaluating instructor, The SDI referral program is designed to allow ANY active instructor to evaluatethe Open Water skills and performance of a referring student. An active instructorrefers to any instructor that is affiliated with an international recognized dive trainingagency. We appreciate your assistance with my student referral. Please review the list ofrequired student skills, dives and instructor pre-requisites before the start of the openwater evaluating process.Evaluating Instructor must: ____ Be an Active Instructor with an internationally recognized training agency. ____ Review students’ Medical History Form. ____ Have referring student sign your facility’s waiver and release form. ____ Evaluate & initial all the required open water skills and dives listed on the back on this form. ____ Sign this referral form. ____ Give the original referral form to student, and retain a copy of this referral form for your records. Thank you for your professional expertise and cooperation.Open Water Global Referral Form Page 2 of 3Copyright © 2002 by Scuba Diving International (SDI) Revision 2.1, 10/10/02
  • 21. Open Water Global Referral Form 18 Elm Street, Topsham, Maine 04086 Phone: (207) 729-4201 Fax: (207) 729-4453 Skill Performance Record Evaluating Open Water Instructor Must Initial Each Skill When Completed• Scuba System • Buoyancy Control ____ Assembly & Disassembly ____ Hovering• Pre-Dive Check ____ Controlled Ascents ____ Self & Buddy ____ Controlled Descents ____ Underwater Communication • Weight System Adjustment• Computer Use ____ Removal & Replacement ____ Reading & Understanding Gauges • Out of Air Emergencies• Regulator Use ____ Alternate Air Source ____ Clearing & Recovery ____ Share Air with Buddy while making a• Mask Clear at Depth controlled ascent ____ Partial ____ Swimming ascent ____ Full • Rescue Techniques• BCD ____ Tired Diver Tow ____ Auto & Oral Inflation ____ Cramp Relief• Entries (Demonstrate 2 types of entries) List type of entries: Open Water Dive Dive Dive Dive Training 1 2 3 4Date (mm/dd/yy)PerformanceStudent InitialsInstructor Initials PASS: I _______________________________, verify that all of the required open water dives and skills ( Print Name of Evaluating Instructor ) for SDI’s Open Water Scuba Diving Course have been successfully performed by the student. _______________________________________________________, #__________________ (Signature of Evaluating Instructor) Instructor # _________________________________________, Date: _______/________/________ Agency Month Day Year INCOMPLETE. Reason:_____________________________________________________ THE ORIGINAL FORM IS TO BE GIVEN BACK TO THE STUDENT, IN ORDER FOR THE STUDENT TO RECEIVE THE FINAL CERTIFICATION FROM THEIR INSTRUCTOROpen Water Global Referral Form Page 3 of 3Copyright © 2002 by Scuba Diving International (SDI) Revision 2.1, 10/10/02
  • 22. Solo Diving Liability Release And Assumption Of Risk Agreement 18 Elm Street, Topsham, Maine 04086 Phone: (207) 729-4201 Fax: (207) 729-4453 THIS IS A RELEASE OF YOUR RIGHTS TO SUE! READ IT CAREFULLY. FILL IN ALL BLANKS. INITIAL EACH PARAGRAPH BEFORE SIGNING.I, _______________________, hereby affirm that I have been advised of the inherenthazards of solo scuba diving. Further, I understand that such diving involves certaininherent risks including, but not limited to, drowning, decompression sickness,embolism, oxygen toxicity, inert gas narcosis, marine life injuries and other types ofbarotrauma and/or hyperbaric injuries. I further understand that by diving alone, I maynot have a dive buddy to assist me should any of these, or any other, diving malady oraccident occur while I am solo diving.I, _____________________, understand and agree that neither my instructor(s):________________, the facility __________________ through which I receive myinstruction, nor SDI, Inc, nor any of their respective employees, officers, agents orassignees, nor the dive vessel, nor the dive operation through which I am granted theprivilege of solo diving, nor my dive buddy, nor other participants in this solo divingactivity (hereinafter referred to as Released Parties) may be held liable or responsible inany way for any injury, death or other damages to me or my family, heirs or assigneesthat may occur as a result of my participation in solo diving as a result of the negligenceof any party, including the Released Parties, whether passive or active.I, _______________________, in consideration for being allowed to solo dive, herebypersonally assume all risks in connection with this activity for any harm, injury, ordamage that may befall me while I am solo diving, including all risks connectedtherewith, whether foreseen or unforeseen, even if caused by the negligence of theReleased Parties.I, _______________________, further save and hold harmless the Released Partiesfrom any claim or lawsuit by me, my family, estate, heirs or assignees arising out of myenrollment and participation in solo diving, including all claims arising before, during,and after this solo diving activity, even if caused by the negligence of the ReleasedParties.I, _______________________, further state that I am already a certified diver and havebeen truthful in stating my qualifications as a certified scuba diver, and have thefollowing certifications from the following training agencies: ______________________that I am aware of the required certification for solo scuba diving, and that I meet allrequirements. I have been a certified scuba diver since: ______, and have been divingfor: ______ years for a total of: _____ dives to a maximum depth of: _____ feet/meters(Circle either feet or meters).Solo Diving Liability Release and Assumption of Risk Agreement Page 1 of 2Copyright © 2002 by Scuba Diving International (SDI) Revision 2.1, 10/10/02
  • 23. I, _______________________, understand that the terms herein are contractual andnot a mere recital, and that I have signed this document of my own free act and will.I, ______________________, further state that I am of lawful age and legallycompetent to sign this liability release, or that I have acquired the written consent of myparent or guardian.1. PLEASE COPY THE FOLLOWING STATEMENT (IN ITS ENTIRETY) ON THEBLANK LINES PROVIDED BENEATH THIS PARAGRAPH.2. PLEASE SIGN, DATE AND WITNESS THE FORM WHERE INDICATED.STATEMENT:IT IS MY INTENTION, BY SIGNING THIS INSTRUMENT, TO EXEMPT AND RELEASETHE RELEASED PARTIES FROM ALL LIABILITY OR RESPONSIBILITYWHATSOEVER FOR PERSONAL INJURY, PROPERTY DAMAGE OR WRONGFULDEATH HOWEVER CAUSED, INCLUDING, BUT NOT LIMITED TO, THENEGLIGENCE OF THE RELEASED PARTIES, WHETHER PASSIVE OR ACTIVE. COPY HERE:I have fully informed myself of the contents of this liability release and expressassumption of risk agreement by reading it before I signed it on behalf of myselfand my heirs. I understand this liability release and express assumption of riskagreement expresses the complete and whole agreement between me and theReleased Parties as it relates to the issues set forth herein.__________________________________ _______________________________ Signature of Diver Date Witness DateSolo Diving Liability Release and Assumption of Risk Agreement Page 2 of 2Copyright © 2002 by Scuba Diving International (SDI) Revision 2.1, 10/10/02
  • 24. Diving Accident / Incident Report 18 Elm Street, Topsham, Maine 04086 Phone: (207) 729-4201 Fax: (207) 729-4453The information contained within all of the pages that make up this document is CONFIDENTIAL and PRIVILEGED. Saidinformation is intended solely for the use of the individual to whom it is directed. If the recipient is a person / business other thanthose listed, you are hereby notified that any dissemination, copying, or other use of this communication is strictly prohibited. If youhave received this document in error, please notify SDI (Scuba Diving International) immediately at (207) 729-4201 and destroy thisdocument immediately thereafter. Thank you for your cooperation and courtesy in relation to this matter. Please print or type clearly. It is extremely important that you fill in this form COMPLETELY!Date of Accident: Name of Victim:Location of Accident:Address of Victim:Sex: Age: Was this an Instructional or Supervised Dive?Check all items applicable. Fatality: ___ Bodily Injury: ____ Bends: ____ Embolism: ____ Non-Injury: ____Other (describe):Describe the diving experience of the victim; was he or she a student? Novice diver? Experienced diver?Describe the injuries suffered by the victim:Please provide all details regarding weather conditions (water, visibility, wind, waves etc.):Please provide details of any equipment failure:Please describe any rescue or emergency procedures used and first aid given:Please list any other emergency personnel / Agencies that attended:Narrative Report: Describe the accident and the events leading up to it with your best overview, including the roles of theparticipants. Use additional pages if needed to give a complete account:Your Name: Your SDI Number:Your Address:Your Telephone Number. Day: Evening:Please describe your current diving status (i.e. Active Instructor, Divemaster etc.):Describe your personal participation in the incident (i.e. were you instructing the victim, a witness, called on to assist, etc.):Please list the names, addresses and phone numbers of all other participants, witnesses. Use additional sheets if needed:Copyright © 2002 by Scuba Diving International (SDI) Revision 2.1, 10/10/02
  • 25. Academic Presentation 18 Elm Street, Topsham, Maine 04086 Phone: (207) 729-4201 Fax: (207) 729-4453Topic:Introductions: (Put your Name and Cert # SDI – xx, on the white board) – let students introduce themselves)Time for presentation itself, Hours: Minutes:1. Objective:How do I get the Attention of the student?2. Value / Importance / Objective / Outline / Key-points:Organization and make sure the Information is correct3. Re-State:Review Key Points, Restate Importance4. Challenge:Copyright © 2002 by Scuba Diving International (SDI) Revision 2.1, 10/10/02
  • 26. In-Water Presentation 18 Elm Street, Topsham, Maine 04086 Phone: (207) 729-4201 Fax: (207) 729-4453Introductions (Your Name, Your Divemaster’s Name – Dive Teams)Time for presentation itself, Hours: Minutes:1. Do a Surface Demonstration (to illustrate the skill(s)2. Review Signs (for example: “OK”, “Go Down”, “Your turn to do the skill”, “Stop”, “Re-do”, “Surface”, “I Have a Problem”, “Equalize Ear Problem”)3. Go down together == Students on their knees == Get an “OK” sign from each student == Watch Me Demo!4. Demonstrate the Skill(s) == Remember, Slow & Exaggerated.5. Evaluate each student performing the skill(s) == Get an OK from the student == Shake Their Hand6. Surface With Students7. Re-state the Skill(s) == Discuss Problems and Solutions == Praise and Critique == Challenge8. Thank the Divemaster # Skill Value / Importance / Objective / Outline / Key-points 1 2 3 4 5 6 7 8 9 10 11 12 13 14Re-State: (Praise, Review Key Points (“You are now able to”), Re-state importance, Discuss possibleproblems, Answer questions students may have.)Challenge: (Ask questions to ensure comprehension, Challenge the Student.)Copyright © 2002 by Scuba Diving International (SDI) Revision 2.1, 10/10/02

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