Nervous Wrecks Membership Registration

Take your time to fill out and submit this simple form.

Your Name will be added to the membership list of our Nervous Wrecks Dive Club:

To pay the $5.00 registration fee, press the "PayPal" key to the right.

Use the submit button at the end of the form to send your request.
Your Name:
E-Mail:
Phone:
Contact Preference:
Street:
City/Town:
Certification Agency:
Certification Level:
Dive Site Preference:



Print the following.
Complete in order to participate in club dives.
Read carefully, then sign.
Give to your dive leader.


Nervous Wreck Dive Club Assumption of Risk Agreement 

     I, ________________________________, hereby affirm that I am a certified diver and 
     cognizant of all of the inherent danger of skin and scuba diving and of the basic safety 
     rules for underwater activities.

     I desire to dive with the Nervous Wrecks Dive Club and I understand and agree that the
     purpose of our diving activities is strictly recreational and that it is not the function 
     of the Nervous Wrecks Dive Club to serve as the guardian(s) of my safety.

     BY SIGNING THIS DOCUMENT I ASSUME ALL RESPONSIBILITY FOR PERSONAL INJURY,
     PROPERTY DAMAGE OR WRONGFUL DEATH, EVEN IF CAUSED BY THE NEGLIGENCE OF OTHERS. 
       
     I understand and agree that I am participating in these recreational diving activities
     voluntarily and I agree to be completely responsible for my own actions.

     I hereby declare I am of lawful age and legally competent to sign this Agreement,
     that I understand the terms herein are contractual and not a mere recital, and that
     I have signed this  document of my own free will.

     I HAVE FULLY INFORMED MYSELF OF THE CONTENTS OF THIS AGREEMENT BY READING IT
     BEFORE SIGNING IT AND I AGREE TO ABIDE BY THE RULES LISTED.


     Signature of applicant:  ___________________________________


     Signature of witness:    ___________________________________     Date: _____________