Membership Application

"*" indicates required fields

1General Information

2General Release

3General Information - 2nd Person

4General Release - 2nd Person

Name

This field is for validation purposes and should be left unchanged.

Form Type

Version

Type

Count

Amount Due

MA-Year

Membership Type

General Information

Name:*

First Last

Please fill out address fields below:*

Street Address Address Line 2 City State ZIP Code

Email:*

Enter Email Confirm Email

Phone*

Phone Type

Mobile

Other

Open Water Certification

NAUI

PADI

SDI

SSI

Other

Certification Year

Please enter a number from 1920 to 2030.

Exclude from Club Roster

Address

Phone

Check if you want any of this personal information to be excluded from appearing in the club roster.

GENERAL RELEASE FROM LIABILITY

In consideration of my participation in Marin Scuba Club (“MSC”) activities, I hereby fully release and discharge MSC, its officers, directors, members, course instructors, dive trip leaders, boat owners and skippers, drivers, agents, attorneys and their heirs, successors and assigns (the "released parties"), from any present and future claims, actions and damages, of any kind and nature, including negligence, property damage, personal injury, or wrongful death, arising from my participation in MSC related activities, including, but not limited to social activities. This release includes, but is not limited to, all compensatory, non-economic, consequential, incidental, and punitive damages.

PLEASE READ AND CHECK EACH BOX BELOW

Consent*

I agree*

I am aware that snorkeling, free diving, skin diving and scuba diving, kayaking, boating and other club activities (collectively, “Water Activities”) take place in unconfined waters such as oceans, lakes and rivers. Such waters are subject to tides, current, waves, surge, cold and wind and various marine creatures and Water Activities therefore can be hazardous activities. I voluntarily participate in Water Activities with knowledge of the dangers involved and hereby agree to accept and assume any and all risks of property damage, personal injury and death.

Consent*

I agree*

I am aware that certain recreational and/or social activities of MSC do not involve Water Activities and may take place in parks and campgrounds and adjacent to unconfined waters such as beaches or lakesides, tidal pools, shoreline paths, rocky and sandy surfaces or adjacent to swimming pools and swimming pool surrounds (“Out of Water Activities”). Beaches, tidal pools, shoreline sands, rivers and lakesides are subject to current, tides, waves, surge, cold and wind, marine and other creatures and the shorelines can be hazardous. Swimming pool surrounds can be subject to slipping, falling on the surface or into the swimming pool or other hazards. I voluntarily participate in MSC Out of Water Activities with knowledge of the dangers involved and hereby agree to accept and assume any and all risks of property damage, personal injury and death.

Consent*

I agree*

I understand that Water Activities and Out of Water Activities involve certain risks, including but not limited to, travel to and from the site of the activity, possible negligent or reckless conduct of other participants or strangers, serious injury or death resulting from drowning, near drowning, arterial air embolism, decompression sickness (DCS), collisions with boats, propellers, and vehicles, entanglement with kelp or fishing line, hypothermia, wave and surf-related injuries, and contact with dangerous marine life. I voluntarily participate in Water Activities and Out of Water Activities with knowledge of the dangers involved and hereby agree to accept and assume any and all risks of property damage, personal injury and death.

Consent*

I agree*

I understand that Water Activities and Out of Water Activities in which I participate may be conducted at sites that are remote from available medical assistance and I accept the risk that medical assistance may not be readily available should I become injured.

Consent*

I agree*

I represent that I am in good physical and mental condition. I accept responsibility for evaluating the demands upon my body and psyche that the environment and the activity may subject me to. I understand and agree that if I choose to violate or avoid customary good safety practices, in or out of the water, I assume all risks of injury or death resulting from that decision and hold the released parties harmless therefor.

Consent*

I agree*

I agree to defend and hold harmless the released parties from any claim against them which may arise in whole or in part from my acts or omissions while participating in any MSC activity.

Consent*

I agree*

I agree that this GENERAL RELEASE OF LIABILITY release shall be binding not only on myself, but on my heirs, executors, conservators, personal representatives, successors, agents, and assigns.

I HAVE READ THIS GENERAL RELEASE OF LIABILTY AND FULLY UNDERSTAND THAT BY SIGNING THIS FORM, I AM GIVING UP LEGAL RIGHTS AND/OR REMEDIES WHICH MAY BE AVAILABLE TO ME.

I expressly waive any rights or benefits available to me under the provisions of Section 1542 of the California Civil Code, which provides as follows:

"A general release does not extend to claims that the creditor or releasing party does not know or suspect to exist in his or her favor at the time of executing the release and that, if known by him or her, would have materially affected his or her settlement with the debtor or released party."

I fully understand the statutory language of California Civil Code Section 1542 and, with this understanding, I nevertheless elect to and do assume all risk for claims released under this General Release from Liability.

Full Legal Name*

Date Signed:*

Thank you for your application!

For Member(s)

To pay by Paypal, Venmo, or Credit Card, please click the link in the email message to which this form was attached.

If paying by check, please make payable to "Marin Scuba Club" for $.00 to:

Sue Estey
216 Carmel Avenue
El Cerrito, CA 94530-4117

Please write " - MSC Membership" on your check!

Your membership will become active when we receive payment.
If you have any questions or comments please email membership@marinscubaclub.org!

General Information

2nd Person for Couples Membership Application

Name*

First Last

Email*

Enter Email Confirm Email

Phone*

Phone Type

Mobile

Other

Open Water Certification

NAUI

PADI

SDI

SSI

Other

Certification Year

Exclude from Club Roster

Address

Phone

Check if you want any of this personal information to be excluded from appearing in the club roster.

GENERAL RELEASE FROM LIABILITY

2nd Person for Couples Membership Application

PLEASE READ AND CHECK EACH BOX BELOW

Consent*

I agree*

Consent*

I agree*

Consent*

I agree*

Consent*

I agree*

Consent*

I agree*

Consent*

I agree*

I agree to defend and hold harmless the released parties from any claim against them which may arise in whole or in part from my acts or omissions while participating in any MSC activity.

Consent*

I agree*

I agree that this GENERAL RELEASE OF LIABILITY release shall be binding not only on myself, but on my heirs, executors, conservators, personal representatives, successors, agents, and assigns.

I HAVE READ THIS GENERAL RELEASE OF LIABILTY AND FULLY UNDERSTAND THAT BY SIGNING THIS FORM, I AM GIVING UP LEGAL RIGHTS AND/OR REMEDIES WHICH MAY BE AVAILABLE TO ME.

I expressly waive any rights or benefits available to me under the provisions of Section 1542 of the California Civil Code, which provides as follows:

Full Legal Name*

Date Signed*

Thank you for your application!

For Member(s)

To pay by Paypal, Venmo, or Credit Card, please click the link in the email message to which this form was attached.

If paying by check, please make payable to "Marin Scuba Club" for $.00 to:

Sue Estey
216 Carmel Avenue
El Cerrito, CA 94530-4117

Please write " - MSC Membership" on your check!

Your membership will become active when we receive payment.
If you have any questions or comments please email membership@marinscubaclub.org!