What scuba certification do you (Veteran or First Responder) hold?

Select all you have served in

You MUST be able to swim 200 yards without any swim or buoyancy aids without stopping

You MUST be able to float or tread in water too deep to stand for ten (10) minutes, your face must remain clear of the water for the duration of the exercise.

Once we (Veteran/First Responder and Dive Buddy) have been notified of the two courses dates, we will complete and turn in all prerequisite items no later than one week prior to their start dates and notify our Chapter Team Leader of their completion.

We (Veteran/First Responder and Dive Buddy) understand that we am expected to participate in Undersea Warrior class, conservation, and diving events to support fellow Veterans struggling with PTSD when possible

I hereby affirm that I am aware that skin and scuba diving have inherent risks which may result in serious injury or death. I understand that diving with compressed air involves certain inherent risks; including but not limited to decompression sickness, embolism or other hyperbaric/air expansion injury that require treatment in a recompression chamber. I further understand that the open water diving trips which are necessary for training, for certification and for recreation may be conducted at a site that is remote, either by time or distance or both, from such a recompression chamber. I still choose to proceed with such instructional and recreational dives in spite of the possible absence of a recompression chamber in proximity to the dive site. I understand and agree that Undersea Warriors who promoted this course, nor any dive training agency mentioned, nor their affiliate and subsidiary corporations, nor any of their respective employees, officers, agents, contractors or assigns (hereinafter referred to as “Released Parties”) may be held liable or responsible in any way for any injury, death or other damages to me, my family, estate, heirs or assigns that may occur as a result of my participation in this online course 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 online course, hereinafter referred to as “program,” I hereby personally assume all risks of this program, whether foreseen or unforeseen, that may befall me as a result of this program including, but not limited to, the academics, confined water and/or open water activities. I further release, exempt and hold harmless said program and Released Parties from any claim or lawsuit by me, my family, estate, heirs or assigns, arising out of my enrollment and participation in this program including both claims arising during the program or thereafter. I also understand that skin diving and scuba diving are physically strenuous activities and that I will be exerting myself performing the skills associated with this program, and that if I am injured or die as a consequence of heart attack, panic, hyperventilation, drowning or any other cause, that I expressly assume the risk of said consequence and that I will not hold the Released Parties responsible for the same. I further state that I am of lawful age and legally competent to agree to this liability release, or that I have acquired the consent of my parent or guardian. I understand the terms herein are contractual and not a mere recital, and that I have agreed to this Agreement of my own free act and with the knowledge that I hereby agree to waive my legal rights. I further agree that if any provision of this Agreement is found to be unenforceable or invalid, that provision shall be severed from this Agreement. The remainder of this Agreement will then be construed as though the unenforceable provision had never been contained herein. I understand and agree that I am not only giving up my right to sue the Released Parties but also any rights my heirs, assigns, or beneficiaries may have to sue the Released Parties resulting from my death. I further represent I have the authority to do so and that my heirs, assigns, or beneficiaries will be estopped from claiming otherwise because of my representations to the Released Parties. I HAVE FULLY INFORMED MYSELF AND MY HEIRS OF THE CONTENTS OF THIS LIABILITY RELEASE BY READING BEFORE PARTICIPATING IN THE PROGRAM ON BEHALF OF MYSELF AND MY HEIRS. BY PROCEEDING TO TAKE ANY UNDERSEA WARRIORS ONLINE COURSE I AM AGREEING TO THIS LIABILITY RELEASE. NOTICE TO THE MINOR CHILD’S
 NATURAL GUARDIAN READ THIS STATEMENT COMPLETELY AND CAREFULLY. YOU ARE AGREEING TO LET YOUR MINOR CHILD ENGAGE IN A POTENTIALLY DANGEROUS ACTIVITY. YOU ARE AGREEING THAT, EVEN IF YOUR CHILD USES REASONABLE CARE IN PROVIDING THIS ACTIVITY, THERE IS A CHANCE YOUR CHILD MAY BE SERIOUSLY INJURED OR KILLED BY PARTICIPATING IN THIS ACTIVITY BECAUSE THERE ARE CERTAIN DANGERS INHERENT IN THE ACTIVITY WHICH CANNOT BE AVOIDED OR ELIMINATED. BY PROCEEDING TO TAKE ANY UNDERSEA WARRIORS PROGRAM YOU ARE GIVING UP YOUR CHILD’S RIGHT AND YOUR RIGHT TO RECOVER FROM THE RELEASED PARTIES IN A LAWSUIT FOR ANY PERSONAL INJURY, INCLUDING DEATH, TO YOUR CHILD OR ANY PROPERTY DAMAGE THAT RESULTS FROM THE RISKS THAT ARE A NATURAL PART OF THE ACTIVITY. YOU HAVE THE RIGHT TO REFUSE TO AGREE WITH THIS STATEMENT, AND THE RELEASED PARTIES HAVE THE RIGHT TO REFUSE TO LET YOUR CHILD PARTICIPATE IF YOU DO NOT AGREE TO THIS STATEMENT. DO NOT LET YOUR CHILD PARTICIPATE IN ANY UNDERSEA WARRIORS PROGRAM IF YOU DO NOT AGREE WITH THIS STATEMENT.

We (Veteran/First Responder and Dive Buddy) have agreed to participate in the above identified Undersea Warriors Open Water Diver and Nitrox Certification Program, which we understand may be duplicated and distributed to the general public. We hereby assign and grant to Undersea Warriors and those acting under its permission, all rights, all title and interest in any intellectual property we may have in such Program and the unqualified right to use my image, name, likeness, voice and information about us for all purposes, commercial, web/social media, or otherwise as the Undersea Warriors sees fit including publicity about the Program or promotional purposes. We also understand that our voice and likeness may be recorded and /or edited, and that it may be published in any manner and for uses that the Undersea Warriors Foundation may deem appropriate. We agree that my name, likeness, voice and information about me may be used for publicity about the Program or promotional purposes. We (Veteran and Dive Buddy) hereby release Undersea Warriors, its licensees and assignees, from all claims or causes of action that may arise in whole or in part from the broadcast or any other use of a promotion for such a Program, including, but not limited to, invasion of privacy rights, defamation and violation of any intellectual property right that we have in such Program.

We (Veteran/First Responder and Dive Buddy) understand and agree that for the purpose of diver training and travel planning, Undersea Warriors will retain the personal information we have provided to them during our training which includes, but is not limited to, our name, mailing address, phone number, date of birth, photography, and passport number. This personal information will be stored in Undersea Warriors’ database. Undersea Warriors will take the reasonable steps to ensure that this data is protected. This personal information will be stored in Undersea Warriors’ database. Undersea Warriors will take the reasonable steps to ensure that this data is protected. We consent to Undersea Warriors accessing this information for purposes of verifying our information and completing our training.

We (Veteran/First Responder and Dive Buddy) will provide an updated Medical Statement form with my physicians signature if we have any changes in our medical profile.

If our (Veteran/First Responder and Dive Buddy) contact information changes, we will let the staff of Undersea Warriors know.

We (Veteran/First Responder and Dive Buddy) notify the Undersea Warriors staff immediately of any change in our medical condition.

I will communicate as quickly as possible with my instructor, my chapter, and Undersea Warriors. The best form of communication for me is (please check all that apply):